Storytelling for Health Promotion: A Scoping Review

Abstract

Objective

To examine storytelling interventions as health promotion tools in underserved populations across disease states, including hypertension, diabetes, overall chronic disease, obstetric care, and preventative health to assess intervention design and cultural tailoring and analyze reported quantitative and qualitative health outcomes.

Data Source

A comprehensive literature search was performed in PUBMED.

Study Inclusion and Exclusion Criteria

Studies were included if they implemented a storytelling intervention to promote health knowledge, behavior change, or health-related outcomes. Excluded studies lacked an evaluated intervention or reported outcomes. Reviews, commentaries, editorials, protocols without outcome data, and duplicate publications without novel findings were excluded. Only English-language studies were included due to reviewer fluency.

Data Extraction

Twenty-five studies were included and categorized based on disease focus.

Data Synthesis

A narrative synthesis and inductive content analysis was performed. Studies were grouped by disease state and analyzed for population demographics, intervention development and delivery, cultural tailoring, storytelling theory, and measured outcomes.

Results

Storytelling, in digital and oral formats, improved health knowledge, self-efficacy, and preventive behaviors. Several methods were employed to culturally tailor interventions. Interventions were based on multiple behavioral theories.

Conclusions

When culturally tailored and rooted in theory, regardless of delivery format, storytelling can foster behavior change across diverse health conditions.

Objective

In this scoping review, we aim to examine storytelling interventions as health promotion tools in underserved populations across disease states, including hypertension, diabetes, overall chronic disease, obstetric care and preventative health. We focus on how these interventions are designed and culturally tailored, as well as the quantitative and qualitative health outcomes reported.

Introduction

Since the emergence of language, humans have used storytelling to communicate information and impart generational knowledge. Storytelling is a particularly effective tool because of the element of personal narrative and engagement [1]. Personal anecdotes evoke strong emotions in listeners and foster a sense of empathy, connection, and personal relevance [2]. Storytellers themselves gain a sense of empowerment and experience feelings of wellbeing from sharing their narrative [3]. Through giving people a voice and hearing from peers with similar lived experiences, storytelling can increase confidence and self-efficacy for both the storyteller and listener [4]. These effects can be amplified in group storytelling, as shared experience and community is built [5]. Additionally, as a learning and teaching tool, storytelling is more engaging than traditional teaching platforms as it incorporates experiential elements and facilitates collaboration [5], can overcome barriers to literacy [6], and is adaptable for different story types and cultures [7].

Storytelling has been used to convey health-related knowledge particularly for centuries by various cultures. For example, indigenous communities have used storytelling in the form of oral tradition to communicate disease treatment and prevention information within communities and across generations [8]. Since the 1990s, storytelling has been increasingly used by public health practices as an intentional strategy for health promotion with “Photovoice”, described by Wang and Burris in 1997 [9].

Several theories exist to explain why storytelling is especially effective for health promotion. One is transportation theory, which suggests that those listening to a story are “transported into a narrative world” [10] that can lead to real-world belief and positive behavior change. When a listener is immersed in a story, they can learn new behaviors via vicarious experience. This process is further strengthened by homophily, or a connection with the characters in a story. The combination of these two properties has been shown to lead to change in health attitudes, skills, and behaviors [4]. Another is Albert Bandura’s social cognitive theory, which suggests that storytelling influences health behavior by providing listeners with role models that allow for observation, learning, and development of self-efficacy and motivation [11].

Storytelling for health promotion is thought to be especially beneficial for communities and cultures that have a strong history of oral traditions, including Latinx, African American, and Native American/Alaskan communities [8, 12, 13, 14, 15]. Since these populations are at increased risk for chronic disease as compared to majority populations, storytelling is a promising intervention to address health disparities [16, 17]. It is important to note that in the contemporary digital age of high internet and technology penetration, storytelling has evolved as a health promotion strategy. Digital storytelling has emerged to leverage technology to amplify voices from underserved communities, utilizing cultural relevance in health promotion [18]. Despite recognition as a powerful communication tool, the research surrounding storytelling’s use in health promotion is under-synthesized. Existing research focuses on outcomes in single populations and specific diseases states with limited exploration of how storytelling interventions are designed, culturally tailored, and evaluated across disease states, especially in underserved communities. This scoping review addresses these gaps by examining storytelling interventions as health promotion tools in underserved populations across disease states, including hypertension, diabetes, overall chronic disease, obstetric care, and preventative health. We focus on how these interventions are designed and culturally tailored, as well as the quantitative and qualitative health outcomes reported.

Methods

Design

This study was designed as a scoping review because this is the most appropriate methodology to map key concepts, identify knowledge gaps, and synthesize evidence that spans a heterogenous body of literature [19]. The methodology was designed based on pre-existing scoping review frameworks, such as the Arksey & O’Malley Framework (2005), and included the following steps: 1) research question identification, 2) research studies identification, 3) study selection, 4) data charting, 5) compiling, summarizing, and reporting results [20]. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-Scr) was used to guide our methods (Figure 1) (Supplementary Material 1) [21].

Figure 1.

Flow diagram illustrating the study selection process for the scoping review. A total of 475 records were identified through database searches. After removal of duplicates and screening for relevance and eligibility, 25 studies met inclusion criteria and were included in the final synthesis.

Data Sources

In this scoping review, we selected studies to include via searches with PUBMED. Given our focus on health promotion interventions targeting biomedical outcomes in underserved populations, PUBMED was the most relevant and high-yield database for this search. Searching from February 1990 through February 2023, we combined terms such as “storytelling” with “hypertension”, “diabetes”, “chronic disease”, “pregnancy”, and “preventative health”. To supplement the PUBMED search, we also conducted backward citation tracking of included articles to identify any additional relevant studies. These searches were performed by five trained research assistants. Each study was reviewed independently by two research assistants. If consensus was not reached through discussion, a third reviewer was consulted.

Inclusion Criteria

Studies were included if they implemented an intervention where storytelling was a core component and was aimed at promoting health knowledge, behavioral change, or health-related outcomes. Storytelling of all forms, including oral, digital, and via physical mediums, were included. Inclusion criteria included randomized controlled trials, feasibility studies with preliminary outcome results, and pre-post-studies.

Exclusion Criteria

We excluded studies that used storytelling solely as a data collection or qualitative research method (e.g., narrative inquiry without intervention), as well as general health education studies that did not incorporate personal narratives or storytelling elements. Papers that discussed the potential of storytelling, but did not evaluate or describe a novel intervention, such as review papers, commentaries, editorials, and conceptual papers, were excluded as they did not present original data. Studies without reported outcomes, such as protocols, descriptions, and feasibility trials without outcome evaluation, were also excluded. Studies that reported on the same intervention without providing novel results were excluded. Only studies published in English were included due to limitations in translation capacity and reviewer fluency. We acknowledge this may have excluded relevant studies conducted in non-English-speaking contexts. However, the majority of storytelling interventions identified in underserved populations were either conducted in English-speaking settings or conducted in native languages with results published in English.

Data Extraction

Five researchers extracted data systematically using a standardized template developed collaboratively by co-authors. Each article was reviewed by two researchers independently to ensure accuracy and consistency. Discrepancies were resolved through discussion, and when necessary, a third reviewer was consulted to reach consensus. Data were extracted based on participant demographics, study characteristics, intervention details, and outcome measures. Demographic information extracted included age, race, ethnicity, and geographic location. Study characteristics included sample size and study design. Intervention details included the target health condition, mode of intervention, goal of intervention, development of intervention, cultural tailoring, and storytelling theories used. Outcome measures included both quantitative and qualitative outcomes related to the effectiveness of the intervention. Outcome measures excluded feasibility data.

Data Synthesis

A narrative synthesis and inductive content analysis was performed to identify key themes regarding intervention design, cultural tailoring, and reported outcomes. Studies were stratified by disease state, such as, hypertension, diabetes, other chronic conditions, obstetric care, and preventative health, to highlight how storytelling interventions were adapted to different clinical contexts. Within each disease category, we analyzed intervention development and delivery, target population, quantitative and qualitative outcomes, with special attention to how cultural relevance was incorporated. This approach allowed for a structured comparison of storytelling interventions across diverse disease states while focusing on cultural adaptation.

Results

Study Characteristics

A total of 25 studies were included, ranging from publication years 2007 to 2022. Most were conducted in the United States, with others in Nigeria, Mali, Vietnam, Iran, Australia, and the United Kingdom. Study designs were primarily quantitative: over half were randomized controlled trials (RCTs), including several pilot RCTs, with the rest being quasi-experimental, pre–post evaluations, or qualitative studies. Sample sizes ranged from small pilots (under 30 participants) to over 400 participants. All interventions centered on storytelling as a health promotion tool in underserved populations, targeting groups such as Latinx, African Americans, Native/Indigenous communities, immigrants/refugees, rural residents, seniors, and low-income youth. Delivery modes varied: many used digital or video storytelling (e.g., DVD, tablet, text messaging), while others employed in-person oral storytelling and written narratives. Nearly all were culturally tailored and involved storytellers as co-creators from the target community, relevant language, and culturally resonant themes. A wide range of outcomes were reported, including clinical measures (e.g., blood pressure, HbA1c), health behaviors (screening uptake, medication adherence, smoking cessation), and psychosocial outcomes (knowledge, self-efficacy, attitudes) (Tables 1–5).

Table 1.

Identified studies where storytelling interventions targeted hypertension

Disease State	Ref #	Study (Author, Year)	Type of Study	Location of Study	Study Population Demographics	Type of Storytelling	Story Creators	Cultural Tailoring	Delivery Mode	Theoretical Framework	Outcomes Reported
Hypertension	[22]	Houston et al. 2011	RCT	Birmingham, Alabama, US, Inner-city safety-net clinic	299 African American patients (71.4% women; mean age: 53.7; 84% low-income)	Real patient stories about hypertension experiences, behavior change strategies, and interactions with physicians	14 African American patients from the local community selected through focus groups and interviews	Stories were from patients within the same community; reflected shared experiences, language, and cultural context	Interactive DVDs (3 total), shown in clinic then mailed; allowed patients to select which stories and educational segments to view	Health Belief Model and Narrative Communication Theory (focus on identification, engagement, behavior modeling)	Uncontrolled hypertension group: Systolic BP decreased by 11.2 mmHg more than control at 3 months (p=0.012); diastolic BP decreased by 6.4 mmHg (p=0.012). 6–9 months: Intervention advantage persisted for systolic (−6.4 mmHg; p=0.012); diastolic non-significant. Controlled hypertension group: No significant difference. Engagement: High – average of 87.5 minutes watched; all intervention patients watched at least one video segment
Hypertension	[23]	Nguyen et al., 2018	RCT	Vietnam	160 rural Vietnamese adults aged ≥50 with uncontrolled hypertension; 54% men; mean age 66	Video stories of local patients discussing personal experiences managing hypertension	Patients from rural Vietnamese communes selected via facilitated story development groups	stories recorded in Vietnamese, based on cultural norms and traditional practices including use of traditional medicine and mindfulness	DVDs over 12 months, with post-media interviews	Implicit narrative engagement theory, based on U.S. protocols adapted for local culture	Systolic BP reduction: 10.7 mmHg (95% CI: 6.5–14.9) in storytelling vs. 5.8 mmHg (95% CI: 1.6–10.0) in didactic. Diastolic BP reduction: 6.6 mmHg vs. 3.8 mmHg. Improved self-reported behaviors: increased physical activity, reduced salt and alcohol intake. High acceptability: 96% found language understandable, 92% said culturally acceptable, 76% felt it encouraged lifestyle change
Hypertension	[24]	Houston et al., 2017	RCT	U.S. Veterans Affairs (3 VA facilities: 1 smaller Southern US city with large rural catchment area, 2 major metropolitan areas in Midwest and Mid-Atlantic)	African American Veterans (92% male, 39% over 65, 40% had limited health literacy)	Peer storytelling via DVD	African American Veterans with controlled hypertension	Veteran-to-Veteran storytelling, culturally relevant stories selected by African American Veterans	DVD	Narrative communication Theory, transportation theory	No significant BP change overall; however, among Veterans with controlled BP at baseline, intervention group had significantly smaller BP increase (SBP +6.3 mm Hg vs. +10.9 mm Hg; P=0.02). Strong site variation noted. Intervention increased emotional engagement
Hypertension	[25]	Lacey et al, 2021	Feasibility Study (non-randomized, prospective cohort)	7 rural parishes in northeast Louisiana, US	99 adults aged >65 with hypertension; 92% African American; 74% female	Digital storytelling via short video clips (<5 min) of peer narratives	Hypertensive patients with well-controlled BP and no unplanned encounters in prior 6 months	storytellers matched listeners in age, race, gender; tailored to rural, African American seniors	Monthly video viewing on tablets for 16 months at senior centers	Implicit narrative engagement and peer modeling principles (not explicitly named)	Unplanned provider visits: 93% of listeners had none during 16-month follow-up. ED visits: 94.9% had none. Hospitalizations: 94.9% had none

Abbreviations: RCT = randomized controlled trial

Table 5.

Identified studies where storytelling interventions targeted preventative health

Disease State	Ref #	Study (Author, Year)	Type of Study	Location of Study	Study Population Demographics	Type of Storytelling	Story Creators	Cultural Tailoring	Delivery Mode	Theoretical Framework	Outcomes Reported
Colorectal Cancer	[34]	Larkey & Gonzalez, 2007	RCT	Arizona, US	64 Latino adults; mean age 46.8; 86% female; 49% aged 50+; English or Spanish speakers	Culturally aligned storytelling and screening information	designed by researchers to reflect cultural values	adapted for Latino cultural norms and delivered in English or Spanish based on preference	in-person storytelling intervention	narrative persuasion and cultural tI2ailoring principles; informed by Kreuter's cultural targeting and Green’s transportation theory	Participants in the storytelling group reported a significantly higher intent to increase vegetable intake (p = .030). Participants in the storytelling group reported a significantly higher intent to add more minutes of exercise (p = .018). Most participants in both groups (storytelling and numeric risk) intended to recommend CRC screening to friends and family. Participants in the storytelling group aged 50+ expressed greater intent to obtain an endoscopy and encourage others to do so
Colorectal Cancer	[35]	Larkey et al., 2009	RCT	Arizona, US	78 underserved Latina women, mostly low income, Spanish-speaking, low literacy	Fictional composite story co-created by promotoras based on lived experiences	Latina promotoras and female staff	developed by Latinx and female creators specifically for Latina culture, reflecting gender roles, family, community	Face-to-face storytelling by promotoras in Spanish	Narrative engagement and identification; risk communication theories	Increased intent to obtain endoscopy (P = .038); increased intent to recommend screening to others (P = .011); all participants reported plans to increase fruit/vegetable intake and physical activity. Fear of CRC decreased overall; perceived risk increased in ST vs. decreased in RT group
Cancer Prevention	[36]	Cueva et al., 2015	Qualitative study	Rural Alaska, US	15 Alaska Native adults (13 women), aged 25–54 (avg. 40); all from small rural communities	2–3 minute digital videos with personal narratives by CHA/Ps using images, music, and voiceovers		Indigenous storytelling traditions integrated; culturally respectful and community-centered narratives	Shared in clinics, homes, Facebook, community settings, and via web	Narrative as Culture-Centric Health Promotion Model (Larkey & Hecht); Indigenous theory emphasizing relationships (Wilson, 2008)	Viewers described increased cancer awareness, emotional engagement, and improved willingness to discuss cancer. Six viewers reported health behavior changes (e.g., quitting smoking, changing diet), and all described encouraging others to adopt healthier behaviors. Viewers found digital stories culturally relevant, respectful, and useful for initiating conversations about cancer
HPV Vaccination/ Cervical Cancer Prevention	[37]	Crippin et al., 2022	Community-based Intervention	Mali	Women aged 18+, low literacy, urban	Visual storytelling via culturally designed	GAIA Vaccine Foundation in collaboration with local Malian artists and public health professionals	West African pagne (printed cloth) is a longstanding tradition and is used to carry messages, commemorate events, or convey meaning in some form, local proverbs, culturally relevant imagery	Visual cloth, education sessions, community gatherings, radio/TV, clinic-based outreach	implied Social Cognitive Theory	5-fold increase in cervical cancer screening uptake (from 665 to 3,701 women). Increased knowledge of HPV and CC among participants exposed to the campaign. 93% of participants wanted more health education sessions. 94% of education session attendees shared information with others. Increased willingness to vaccinate daughters against HPV. Preference for clinic-based HPV vaccination campaigns. Visual cloth was interpreted correctly even without session attendance (80%)
HPV Vaccination/ Cervical Cancer Prevention	[38]	Kim et al., 2020	RCT	Northeastern United States	104 Korean American college women, aged 18–26; 79% born in South Korea; 73% undergraduate; 61.5% in non-health majors; 75% Christian	Peer-paired, cross-generational video stories of Korean American college women	Korean American peer participants and researchers	co-created with participants and tailored for Korean American culture and younger generation	web-based, mobile-accessible video	Storytelling/Narrative Communication (SNC) Theory; Situation-Specific Theory (Kim et al., 2017)	HPV vaccination uptake was higher in the storytelling group (15.6%) than control (7.1%), though not statistically significant (p=0.317); Intention to vaccinate increased 144.4% in the storytelling group vs. 66.7% in control; Knowledge improved significantly in both groups (p<0.001), with a greater mean increase in the storytelling group (Δ=11.5 vs. 8.8; p=0.04); Attitudes improved in both groups (p<0.001), but between-group difference was not statistically significant (p=0.06)
HPV Vaccination/ Cervical Cancer Prevention	[39]	Chen et al., 2022	Pre-post intervention study	US in the Vietnamese community	114 Vietnamese-American mothers of unvaccinated children (mean age 41.5; 35.2% immigrants)	Digital audiovisual stories	Two first-generation Vietnamese-American mothers	Stories produced in Vietnamese and English; culturally grounded in Vietnamese beliefs and practices	3-minute digital stories shown during a brief intervention	not explicitly stated	HPV vaccination intention increased from 53% to 74% (OR = 9.12, P < 0.001). Significant improvement in attitudes toward HPV vaccination. High identification and engagement with stories based on narrative quality scores
HPV Vaccination/ Cervical Cancer Prevention	[40]	Lee et al., 2017	RCT	Massachusetts, US	9 Cambodian American (Khmer) mother–daughter dyads, Daughters aged 14–17, Cambodian American, many with linguistic barriers	Culturally grounded narrative videos developed using personal stories and community input, Narratives addressed HPV vaccination-related messages	Research team collaborated with Cambodian American community partners using Community-Based Participatory Research methods,	Videos were culturally and linguistically adapted for Khmer mothers and daughters, incorporated community-specific barriers and facilitators to HPV vaccination	Video storytelling intervention delivered as a session to mother-daughter dyads	Narrative Theory and Revised Network Episode Model (rNEM)	Vaccine uptake at 1-month follow-up was equal in both groups (2/19). Intention to vaccinate was higher in the narrative group (4 vs. 1)
HIV/AIDS Prevention	[41]	Ezegbe et al., 2018	RCT	Nigeria	80 junior secondary schoolchildren (equal male/female, public & private schools, age ~14.8)	Digital storytelling using rational emotive behavior therapy (REBT)–informed audiovisual narratives	External social media sources (e.g., YouTube/Facebook); students retold stories	targeted to Nigerian youth, gender-informed, culturally relevant concerns	group and home video viewing and storytelling sessions	Rational Emotive Behavior Therapy (REBT)	Significant increase in HIV/AIDS knowledge and perceived risk of HIV at post-test and 4-week follow-up; sustained gains in both domains; validated with HIV-KQ-18 and PRHS instruments; eta2 > 0.47 for all key outcomes
HIV Prevention	[42]	Ofoegbu et al., 2020	RCT	Nigeria	98 Nigerian adolescent college students (mean age ~20.4 years)	Educational digital storytelling (EDSI)	Developed by therapists with expertise in digital storytelling and HIV education	Culturally contextualized for Nigerian adolescents	16-session, 8-week audio-visual group intervention	Cognitive-behavioral and rational emotive frameworks	Significant increase in HIV knowledge and perceived HIV risk in the intervention group (p < 0.001). Large effect sizes: η2p = 0.976 (knowledge), η2p = 0.908 (risk perception). Gains were sustained at 2-month follow-up
HIV/AIDS Prevention	[43]	Dike et al., 2021	RCT	Nigeria	84 children aged 9–14; 54% boys, 46% girls; 81% Igbo, 15% Hausa, 5% Yoruba; all spoke English	Educational digital storytelling videos featuring animated and personified characters with group psychoeducational discussions	Intervention designed by experts in education, psychology, communication, and social work (not the children themselves)	characters and setting designed for rural Nigerian children using familiar imagery and older child role models	Group video sessions and take-home videos; shown in town hall and via social media	draws on media-based health behavior change strategies and implicit cognitive-behavioral and education theory	Significant improvement in HIV knowledge (HIVKQ-18) and perceived risk (PRHS) post-intervention and at 3-month follow-up (p < 0.001). No significant pre-intervention differences. Large effect sizes (R2 = 0.869 for knowledge; R2 = 0.979 for risk perception)
HIV/STI Prevention	[44]	Hill & Coker, 2022	RCT	Texas, US	26 cisgender Black women, ages 18–45, recent condomless heterosexual sex,	Non-fictional and fictional case-based video storytelling	Researchers and actors	Storytelling incorporated culturally relevant scenarios, colloquialisms, and settings familiar to Black women	Tablet-based video logs in ED	informed by narrative and cultural relevance models	Storytelling increased knowledge in 2 areas but showed significant decreases in 6 areas; Taboo increased knowledge in 1 area, with decreases in 8 areas; no change in 3 areas; vlogs were feasible but not effective in improving HIV/STI knowledge, some knowledge was even undermined post-intervention
Substance Use, STIs/HIV, Teen Pregnancy Prevention	[45]	Cordova, et al., 2020	RCT	Southeast Michigan, US	50 youth (ages 13–21), 50 youth (82% female; 46% White, 42% Black, 2% Native American, 8% multiracial, 2% Other; aged 13–21); 7 clinicians (86% female; 71% White, 14% Hispanic/Latino, 14% Asian)	short animated storytelling scenarios in a digital app	youth leadership council and researchers	co-created with youth so it is developmentally and culturally congruent	mobile health (mHealth)	Ecodevelopmental Theory and Empowerment Theory	Clinician-youth communication improved (Youth M=3.22 vs. 2.96; Clinicians M=3.47 vs. 3.23); Prevention knowledge increased (STI/HIV Δ=0.25, tobacco Δ=0.30); Self-efficacy improved (alcohol refusal Δ=0.22, drug refusal Δ=0.09, condomless sex refusal Δ=0.08); Substance use reduced (12% decrease; drug use Cohen h=1.28); Sexual risk behaviors reduced (condomless sex −10%, alcohol before sex −5%; Cohen h=0.18–0.44); STI/HIV testing uptake improved (52% vs. 44%; Cohen h=0.16)
Early Childhood Caries	[46]	Heaton et al., 2019	Pretest–posttest design	Northern California, US	53 American Indian/Alaska Native (AIAN) pregnant women or mothers of children ≤6 years; median age 29; all self-identified as AIAN	Traditional oral storytelling using a culturally specific tale (“Coyote and Little Man”)	Developed with traditional storytellers, AIAN Community Advisory Board, and Early Childhood Caries experts	featured culturally resonant figures (Coyote trickster), co-developed with community leaders, used a talking circle format	In-person group storytelling session followed by talking circle	Theory of Planned Behavior	Oral health knowledge/beliefs score significantly improved from baseline to posttest (mean increase from 21.6 to 24.1, P < 0.001) and remained elevated at 6 months (mean = 23.6, P = 0.035 from posttest); Positive oral health behaviors significantly improved from baseline to 6-month follow-up (P < 0.001), including brushing frequency, reduced sugary foods/drinks, and improved use of dental care; Sustained improvements across demographic subgroups; effect sizes for gains in knowledge and behaviors were moderate to large (partial η2 = 0.446–0.484)

Abbreviations: RCT = randomized controlled trial

Approximately two-thirds of the studies also identified a guiding theoretical framework (Tables 1–5), with the most common being Social Cognitive Theory, Narrative Communication Theory, and Transportation Theory. Each of these informed how storytellers modeled behaviors, encouraged identification, or structured emotionally engaging narratives. Several studies used the Health Belief Model, the Theory of Planned Behavior, or combinations of behavior change models. Community and youth focused interventions often used Empowerment Theory, Ecodevelopmental Theory, or principles of narrative medicine and Indigenous knowledge systems. Smaller pilot or community-driven projects used narrative techniques without explicitly citing formal theory.

Hypertension

Four studies used storytelling interventions to address hypertension (Table 1). All delivered patient stories through video and matched storytellers to the participants’ culture or community. In two RCTs, patients with hypertension who viewed culturally tailored hypertension story videos had significantly greater reductions in systolic blood pressure (10 mmHg or more) compared to control groups, though only those with uncontrolled hypertension benefited in one of these studies [22, 23]. Another RCT in African American veterans found no overall blood pressure improvement from a peer storytelling DVD, although those who started with controlled blood pressure were more likely to remain controlled [24]. A community-based program for older rural African American adults, involving monthly digital story sessions, reported that 93% of storytelling participants had no unplanned hypertension-related visits over 16 months, suggesting better self-management [25] These studies suggest that narrative communication may be associated with blood pressure reduction and maintained control in these populations.

Diabetes

Five studies used storytelling to address diabetes management (Table 2). Four studies focused on Type 2 diabetes and one study focused on Type 1 diabetes. Participants were largely from minority or underserved groups, including Latinx, African American, immigrant, and rural communities. The storytelling formats ranged from video testimonials and group sessions to animated stories for youth, all with culturally appropriate content. Overall, the interventions improved self-care behaviors or confidence, but clinical outcomes showed mixed results. Two studies in rural African American adults found that compared to standard education, narrative-based education improved self-efficacy and certain practices such as healthier food choices and foot care [26, 27]. However, HbA1c reductions were minimal [26, 27]. In a larger RCT, patients who watched peer diabetes stories had better medication adherence than controls, but no significant short-term difference in glycemic control [28]. Smaller pilot studies also demonstrated improved confidence in diabetes management after culturally tailored story interventions [29]. An RCT of an animated storytelling program for adolescents with Type 1 diabetes showed significantly improved self-management scores in the intervention group [30]. These findings suggest that while storytelling may not dramatically change biomarkers like HbA1c in the short term, it consistently enhanced engagement and self-management skills.

Table 2:

Identified studies where storytelling interventions targeted diabetes

Disease State	Ref #	Study (Author, Year)	Type of Study	Location of Study	Study Population Demographics	Type of Storytelling	Story Creators	Cultural Tailoring	Delivery Mode	Theoretical Framework	Outcomes Reported
Type 2 Diabetes Mellitus	[26]	Utz et al., 2008	Quasi-experimental study with random assignment	Central Virginia, US; rural county	N = 21 African American adults with T2DM; 76% female; Mean age: 60 years; 58% had less than a high school education; Most had comorbidities (e.g., hypertension, cardiovascular disease)	Figurative, culturally relevant oral storytelling by an African American woman used at the start of group sessions	content culturally developed by researchers	Addressed barriers specific to rural African Americans (e.g., stigma, access)	In-person group education at community center	Social Cognitive Theory; Empowerment-based education model	Both groups had slight reductions in A1C (Group: −0.32; Individual: −0.24); Storytelling group showed greater improvements in Carbohydrate spacing (+2.27 vs. −0.14), Comprehensive foot care (+3.64 vs. +0.38), Self-efficacy (+3.58 vs. −1.13), Goal attainment (76% vs. 50%)
Type 2 Diabetes Mellitus	[27]	Williams et al., 2014	2-year feasibility quasi-experimental study	Rural central Virginia, US	25 rural African American adults with T2DM; mean age 62; 80% female; 76% insured; 40% had prior diabetes education; 90% obese	Group-based education with videotaped African American storytelling vignettes on diabetes self-management challenges	Pre-recorded stories developed by the University of Michigan Diabetes Research and Education Center; used to stimulate discussion	Afrocentric approach emphasizing group learning, cultural values, and family involvement; tailored to rural African American context	8 weekly 2-hour group sessions at a rural community center; led by nurse and certified diabetes educator	Social Cognitive Theory (Bandura)	A1C: Decreased from 8.0% to 7.4% over 12 months (Not significant); Systolic BP: Significantly reduced by 13.5 mmHg (P = 0.008); BMI: Significant drop at 3 months (P = .03), maintained at 12 months; Self-care behaviors: Exercise -increased from 2.2 to 3.1 sessions/week (P = .007), Foot care - increased from 4.2 to 5.8 (P = .001); Diabetes knowledge: Improved significantly (P = .001)Diabetes knowledge: Improved significantly (P = .001); Diabetes knowledge: Improved significantly (P = .001); Self-efficacy: Increased from 3.99 to 4.18 (Not significant); Mental health (SF-12): Improved from 39 to 43 (P = .05) at 3 months, sustained; Physical health (SF-12): Declined slightly at 12 months (P = .06)
Type 2 Diabetes Mellitus	[28]	Andreae et al., 2021	RCT	Southeastern US, underserved communities	N = 473 randomized; 403 completed follow-up; Mean age: 57 ± 11; 78% female, 91% African American; 56.4% with high school education or less; 70% had annual income <$20,000	Video-recorded peer storytelling used to anchor discussions in 11 phone sessions	Storytelling content featured real people with diabetes from similar communities	peer coaches were African American community members living with diabetes or caring for someone with diabetes; Designed for low-income, underserved populations with culturally concordant content	11-sessions, 6-month phone-based intervention delivered by trained peer coaches; Storytelling videos used to initiate discussion and reflect common diabetes self-care challenges	Social Cognitive Theory; Chronic Illness Trajectory Framework (focused on integrating self-care into everyday life narratives)	Medication Adherence: Significantly improved in intervention group (β = −0.25, 95% CI: −0.35 to −0.15); Beliefs About Medication Necessity: β = 0.87 (95% CI: 0.27, 1.47); Concerns About Negative Effects: β = −0.91 (95% CI: −1.35, −0.47); Beliefs That Medications Are Harmful: β = −0.50 (95% CI: −0.89, −0.10); Medication Use Self-Efficacy: β = 1.0 (95% CI: 0.23, 1.76); Physiologic Measures (A1c, SBP, LDL-C, BMI): No significant changes; Quality of Life: No significant improvements reported
Type 2 Diabetes Mellitus	[29]	Wieland et al., 2017	Pilot feasibility study with matched control group	Midwest and Southwest US	25 immigrant/refugee adults with T2DM (15 Latino, 10 Somali); 92% foreign-born; 52.8 years average age; 92% had limited English proficiency; 68% unemployed; 80% had ≤ high school education	Digital storytelling video (12–13 minutes) featuring 4 patient-authored stories per language group	Immigrant community members (Latino and Somali) co-created stories via community-based participatory research	culturally and linguistically tailored videos (Spanish/Somali); developed via participatory process with community advisors and storytellers	Video shown during primary care visits in private rooms	Narrative Theory and Social Cognitive Theory	Acceptability: 100% of participants found the video interesting and useful; Self-efficacy: 96% felt more confident managing diabetes; Motivation: 92% felt motivated to change a diabetes-related behavior; Glycemic control: A1C dropped from 9.3% to 8.4% (mean decrease −0.8%, P = 0.02); among Latino participants with A1C ≥ 7%, A1C dropped by −1.5%, P = 0.03; Behavioral intentions: 78% intended to eat healthier, 48% to increase activity or improve medication adherence
Type 1 Diabetes Mellitus	[30]	Zarifsaniey et al., 2022	RCT	Iran	66 adolescents with T1DM (aged 12–18); 58% female; all using insulin; recruited from diabetes clinics	nimated digital storytelling intervention titled "Diabetes and Bumblebee" featuring a cartoon character teaching diabetes self-management in a youth-friendly format	Animation and educational content developed by instructional designer, pediatric endocrinologist, and media team	No specific cultural tailoring described beyond adolescent-centered design	Asynchronous animation-based training	Implicitly based on narrative engagement and asynchronous learning principles	Self-management (SMOD-A total): Significantly improved in intervention group from 92.87 to 100.12 (P = 0.005); no significant change in control group; HbA1c: No significant change observed in either group; Collaboration with Parents: ↑ from 23.78 to 26.06 (P < .001); also significantly higher than control post-intervention (P = 0.022); Diabetes Communication: increased from 24.57 to 26.69 (P = .015); Goals: increased from 13.21 to 15.21 (P < .001); Age effect: Older age negatively correlated with Collaboration with Parents subscale (r = –0.347, P = .048)

Abbreviations: RCT = randomized controlled trial

Other Chronic Diseases

One study focused on heart failure, illustrating storytelling’s potential in chronic illness care (Table 3). In a Native Hawaiian community “talk story” program, patients with heart failure watched videos of local peers sharing their experiences and cultural wisdom about managing the condition [31]. After the intervention, 87% of participants reported the stories helped them understand or manage their heart failure better. Although no control group data was available, this high perceived benefit suggests that culturally tailored storytelling can support self-care and patient education.

Table 3.

Identified studies where storytelling interventions targeted other chronic diseases

Disease State	Ref #	Study (Author, Year)	Type of Study	Location of Study	Study Population Demographics	Type of Storytelling	Story Creators	Cultural Tailoring	Delivery Mode	Theoretical Framework	Outcomes Reported
Heart Failure	[31]	Sentell et al., 2020	Feasibility Study	Honolulu, Hawai‘i, US	N = 35 Native Hawaiian patients with heart failure; Mean age: 57 years; 31% female; 47% had less than a high school education; 74% reported low health literacy; 40% reported substance use; 40% mental health issues; 34% housing instability	“Talk story” format: patients shared their lived experiences of heart failure and recovery in short videos (5–8 minutes) filmed in personal or natural settings	Six Native Hawaiian patients (2 women, 4 men) identified by clinicians as compelling communicators, Stories recorded and edited with community and clinical feedback	emphasized Native Hawaiian oral traditions and local values (e.g., “talk story,” ohana); Setting (e.g., beach scenes), themes, and storytellers reflected cultural values; Participants strongly identified with the storytellers, frequently saying "they are like me"	Videos delivered via iPad in hospital or clinic setting; Participants watched 1–4 videos (up to 20 minutes), followed by open-ended interviews; YouTube versions also made available for broader access	informed by narrative medicine and community-based participatory research principles; methodology adapted from Houston et al.’s work on culturally appropriate storytelling	87% of follow-up respondents (n=15) said the videos helped them; Follow-up (N=35): 26% hospitalized again within 4 weeks; 31% had an ED visit

Obstetric Care

Two studies examined storytelling in obstetric care (Table 4). In an Australian experiment, nulliparous women who read narrative accounts of childbirth had their birth preferences influenced by the tone of the story, depending on if it was positive or negative [32]. Those who read positive birth stories about vaginal births were more likely to prefer it versus C-sections, and vice versa. This indicates the strong influence of narrative framing on attitudes and decision-making processes. In a pilot randomized controlled trial in the United Kingdom, pregnant smokers who received text-message story episodes about a fictional woman quitting smoking were more likely to quit by the end of pregnancy than those receiving usual care [33]. However, the sample size was too small for statistical significance [33]. Together, these studies show that exposure to tailored storytelling interventions can influence delivery method preference and support behavior change during pregnancy.

Table 4.

Identified studies where storytelling interventions targeted obstetric care

Disease State	Ref #	Study (Author, Year)	Type of Study	Location of Study	Study Population Demographics	Type of Storytelling	Story Creators	Cultural Tailoring	Delivery Mode	Theoretical Framework	Outcomes Reported
Birth preferences; childbirth decision-making	[32]	Miller & Danoy-Monet, 2021	RCT	Australia	N = 426 nulligravid women; Mean age: 25.7 years; Majority were Australian residents with university-level education; majority did not identify with a specific cultural group	Written birth stories	Research team developed synthetic, standardized stories designed to reflect real experiences	No cultural tailoring; generalized for nulligravid Australian women	Stories delivered via online Qualtrics survey platform; participants read three birth stories in a randomized condition during the survey	Bandura’s theory of self-efficacy; concepts of childbirth fear and decision-making psychology	Childbirth preference shifted based on type and evaluation of birth story: Positive vaginal and negative caesarean stories increased preference for vaginal birth, Negative vaginal and positive caesarean stories increased preference for caesarean birth; Childbirth fear and self-efficacy expectancy partially mediated the effect of vaginal birth stories on preferences; No significant mediating effects for caesarean stories; Even brief exposure to stories influenced birth preferences among nulligravid women
Smoking cessation during pregnancy	[33]	King et al., 2022	RCT	Scotland and England	Pregnant women (n = 28) who smoked, Ages 16+, Recruited before 14 weeks gestation, Majority from high-deprivation areas	Text-based fictional narrative delivered via SMS	Research team-developed character "Megan"; content informed by story development groups with target population	storyline reflects experiences of disadvantaged pregnant women who smoke; character relatable and realistic	Automated SMS text messages from "Megan" with embedded behavior change techniques; Weekly image updates showing fetal development and weekly summaries	Theory of Planned Behavior; Social Cognitive Theory; Health Belief Model; Protection Motivation Theory; Behavior Change Technique taxonomy	More non-smokers at follow-ups in intervention group, but sample size too small to determine significance; High baseline risk perception and intention to quit; modest improvements in self-efficacy

Abbreviations: RCT = randomized controlled trial

Preventive Health

Several interventions used storytelling to promote preventive behaviors such as cancer screening, vaccination, and HIV/STI risk reduction (Table 5).

Cancer Prevention and Screening:

In two pilot trials with Latinx communities, culturally tailored stories delivered in a telenovela-style video format with promotoras led to higher intention to seek colorectal cancer screening compared to control groups [34, 35] Qualitative feedback from Alaska Native viewers of cancer story videos indicated that culturally relevant narratives heightened awareness and empowered individuals to consider screening [36].

Similar results were seen in four storytelling interventions aimed at cervical cancer prevention. A community storytelling campaign in Mali, where a traditional West African pagne (printed cloth) was used to depict health-related stories, was associated with an increase in cervical cancer screening rates [37]. A peer narrative video program among Korean American women significantly increased HPV vaccine uptake relative to controls [38]. In another digital storytelling intervention among Vietnamese-American mothers, participants viewed 3-minute audiovisual narratives co-developed with immigrant mothers in both English and Vietnamese. After viewing the stories, intention to vaccinate their children increased significantly from 53% to 74% (OR = 9.12, P < 0.001) [39]. In a pilot RCT with 19 dyads of Cambodian American mothers and daughters, a a culturally grounded video intervention guided by the revised Network Episode Model was implemented. Although vaccine uptake at one-month follow-up was the same across groups, intention to vaccinate was higher in the intervention group [40].

HIV/STI Prevention:

In Nigeria, multiple RCTs found that digital stories tailored to Nigerian adolescents led to significantly greater HIV/AIDS knowledge and perceived risk compared to standard education [41, 42, 43]. In a U.S. setting, a narrative-based STI prevention video for young adults yielded mixed results. It improved knowledge in some areas but not in others [44]. Meanwhile, in another U.S.-based study which integrated culturally relevant story vignettes into clinic visits for adolescents, there was an improvement in the quality of provider and youth communication about sexual health topics [45].

Other Prevention and Screening:

An oral storytelling session using a traditional legend to convey infant oral health messages to American Indian/Alaska Native mothers led to significant improvements in mothers’ knowledge about preventing early childhood caries [46].

These studies show that culturally tailored and linguistically adapted storytelling interventions were often associated with improved preventative health outcomes, including increased knowledge, higher intention to screen or vaccinate, and improved provider-patient communication. These trends were observed across multiple forms of storytelling, both oral and digital, and across diverse populations.

Discussion

Key Findings

This scoping review found an expanding body of evidence that storytelling interventions can effectively engage underserved populations and promote healthier behaviors. Across diverse health issues, narrative approaches improved participants’ knowledge, self-efficacy, and intentions. In fact, several studies documented behavior change and clinical improvement, such as blood pressure reduction, improved medication adherence, and increased intention to screen and vaccinate. Storytelling often outperformed standard health education, particularly in underserved communities or communities with histories of storytelling tradition. An important finding was that interventions were most successful when they were culturally tailored to their audience.

Cultural Tailoring and Engagement

This review found that storytelling interventions utilized several methods to culturally tailor stories and their delivery to the target audiences. Many interventions engaged community members as storytellers or co-creators, often selecting individuals of the same ethnicity who spoke the community’s language and addressed culturally specific beliefs and local health concerns. Some interventions drew upon existing oral traditions to deliver health related messages, such as the traditional “Coyote and Little Man” tale in Alaskan Native populations [46]. One study even utilized a traditional physical medium, the West African pagne (printed cloth), suggesting that the cultural significance and resonance of a storytelling medium may be more impactful than the format itself [37]. Most interventions also relied heavily on using true personal narratives or fictionalized but representative narratives, making health messages more believable and emotionally resonant. High levels of engagement and acceptability were reported in these culturally tailored programs, reinforcing that community-driven content is important for storytelling to succeed in health promotion initiatives. Future interventions should continue to use participatory approaches to develop narratives, as co-tailoring and utilizing pre-existing traditions not only yields more resonant stories but also empowers communities by valuing their voices in the process.

Role of Theory in Storytelling Design

A key strength across many of the included studies was the use of theoretical frameworks to guide the design and implementation of storytelling interventions. Theory-based storytelling helps ensure that narratives are not only culturally resonant but also strategically constructed to influence health behaviors. For example, studies using Social Cognitive Theory often designed stories to feature peer models successfully managing a condition, which can boost self-efficacy in viewers. Similarly, interventions rooted in Narrative Transportation Theory aimed to immerse audiences in emotionally compelling stories that encourage reflection and internalization of health messages. This theoretical grounding may help explain the consistent improvements seen in knowledge, attitudes, and behavioral intentions across many studies.

However, several interventions, especially smaller or community-driven ones, did not name an explicit theory, even when narrative mechanisms (like identification, modeling, or emotional engagement) were clearly involved. While these studies often succeeded in engaging participants, the lack of formal theoretical grounding may limit reproducibility or the ability to optimize design for impact. Future research could benefit from explicitly integrating behavioral science and communication theory to guide storytelling structure, message framing, and delivery modality. This would not only enhance intervention rigor but also strengthen the evidence base for storytelling as a mechanism of change in health promotion.

Outcomes and Efficacy

The included studies demonstrate that storytelling can achieve a range of positive outcomes, though results were not uniformly positive for every measure. Knowledge gain was the most consistently improved outcome across studies, and many interventions also increased participants’ confidence and readiness to change (e.g., greater intention to adopt recommended behaviors). Several studies showed follow-through on these intentions, with storytelling groups achieving higher rates of preventive actions or better disease control than comparison groups. These findings align with Narrative Communication Theory, which suggests that storytelling that allows for self-identification and emotional engagement can lead to behavioral change [47]. A few studies saw minimal or no differences in clinical outcomes, indicating that additional support or time may be needed to cause and capture impacts. Overall, no adverse effects were reported from storytelling interventions. At worst, storytelling was no more effective than standard education, and at best it was associated with positive behavioral change and tangible quantitative outcomes.

Strengths and Gaps in the Literature

A strength of the current evidence is that storytelling has been applied to numerous health topics and across diverse populations. Various modes of storytelling have also been studied including traditional in-person, written narratives, DVDs, videos, text messages, and mixed-media modes. This suggests that the format can be adapted depending on resource availability and audience preference. Another strength is that many studies were theory-informed, drawing on behavioral science frameworks to design their storytelling approach. Despite these strengths, the literature has some limitations. Many studies were pilots or had small sample sizes, limiting statistical power to detect effects, especially regarding longer-term clinical outcomes. Many studies were excluded due to lack of outcome reporting as the majority of results assessed feasibility only. There is also considerable heterogeneity in how outcomes were measured, making it difficult to compare effectiveness across studies and standardize data. These gaps highlight opportunities for future research.

Implications for Practice

The positive trends observed suggest that practitioners in health promotion and community health should consider integrating storytelling into their programs, especially for audiences that might be less engaged by traditional education methods. Culturally relevant stories, regardless of mode of delivery, can make health messages more relatable and memorable. In practice, this means collaborating with the community to gather or create personal stories, such as patient testimonials or culturally symbolic tales and traditions that convey healthy practices. This also means involving community members as co-creators and storytellers as well, especially those who can communicate in the target community’s native languages. Storytelling can be incorporated into various settings to enhance engagement. Practitioners should ensure that narratives include accurate health information and clear messages to avoid confusion. By tailoring both the content and the delivery medium to the target population, health promoters can use storytelling to overcome literacy gaps and mistrust, fostering a deeper connection with the audience and potentially improving health outcomes.

Future Research Directions

Building on encouraging findings, future research should pursue larger and more rigorous evaluations of storytelling in health promotion. Longer follow-up periods are needed to determine whether narrative-induced changes in behavior are sustained over time and lead to lasting health benefits. Comparative studies could examine whether adding storytelling to standard interventions yields better results than non-narrative approaches alone. With technological advances and the emergence of artificial intelligence, new forms of digital storytelling, such as choose-your-own adventure adaptive storytelling and virtual/augmented reality warrant investigation as innovative channels for health-related messaging.

Strengths and Limitations

The strengths of this study are that we focused on storytelling interventions with primary outcomes, to show the variety of ways that storytelling can improve health. Both quantitative and qualitative studies were included. We focused on diverse, typically marginalized communities such as underserved minorities, rural geographic areas, various age groups, and women to highlight the diversity of people that storytelling interventions may be effective in. Our review was comprehensive with an analytic approach to searching and synthesizing the available literature focusing on a breadth of themes. A limitation of this study is that we did not include published manuscripts in languages other than English. However, the studies included storytelling in the native languages of the participants. Our review was not a systematic review; therefore, the quality of the studies was not assessed.

Conclusions

This scoping review uniquely synthesizes storytelling intervention design, cultural tailoring, theory, and multifaceted outcomes across a wide range of disease conditions and prevention efforts. Our analysis emphasizes the importance of various cultural adaptation techniques in combination with storytelling theory in designing effective interventions. Few interventions assessed long-term outcomes, representing a key gap for future research. Collectively, the findings emphasize that storytelling is not only a promising modality to enhance health knowledge and promote positive behaviors but can also be a culturally grounded approach to advancing health equity. Future storytelling interventions should prioritize community co-creation, cultural authenticity, and rigorous evaluation to address health disparities in health promotion efforts.

SO WHAT?

What is Already Known on this Topic?

Storytelling is beneficial for communities and cultures that have a strong history of oral traditions, many of which are marginalized populations. It has been used as a health promotion method in public health practice since the 1990s, however, digital storytelling is becoming more common to improve health literacy and behavior.

What Does This Article Add?

This scoping review analyzed 25 studies using storytelling interventions across hypertension, diabetes, chronic illness, obstetric care, and preventive care. Storytelling, especially when culturally tailored, was linked to improved knowledge, self-efficacy, and health behaviors, and in some cases, objective outcomes like lower blood pressure. The review outlines cultural tailoring strategies, such as incorporating cultural traditions and involving target population co-creators, and highlights the use of frameworks like Social Cognitive Theory and Narrative Transportation Theory in intervention design.

What are the Implications for Health Promotion Practice and Research?

Storytelling is a culturally aware, emotionally engaging, scalable, and effective intervention for health promotion that can be integrated into public health efforts to create sustainable health promotion initiative. This is especially relevant to traditionally stigmatized topics such as sexual health and vaccine hesitance, and in marginalized communities. Practitioners should consider integrating storytelling interventions that are rooted in cultural context and behavioral theory into health promotion initiatives. Future research is needed to assess long-term outcomes.

Data availability:

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Storytelling has long been used to share knowledge, foster empathy, and promote health across generations, especially in communities with strong oral traditions, such as Latinx, African American, and Native American/Alaskan populations. Many of these communities continue to face disproportionate burdens of chronic disease, sparking interest in storytelling as a culturally resonant tool for health promotion and health equity. This scoping review analyzes 25 studies that implemented storytelling interventions to promote health knowledge, behavior change, or clinical outcomes in underserved populations across disease areas including hypertension, diabetes, chronic illness, obstetric care, and preventive health. We found that both oral and digital storytelling formats improved health knowledge, self-efficacy, engagement, and preventive behaviors. In several studies, storytelling was also associated with improved clinical outcomes such as blood pressure reduction. Importantly, many interventions were grounded in behavioral theory, such as Social Cognitive Theory and Narrative Transportation Theory, and were culturally tailored through community co-creation, native language use, and incorporation of cultural traditions. This review shows that storytelling, especially when culturally tailored and rooted in behavioral theory, can not only promote health, but also build trust, connection, and agency within marginalized communities. As storytelling continues to evolve in the digital age, this synthesis offers timely insight into how narrative-based health promotion can be designed, tailored, and evaluated to meet the needs of underserved populations. Storytelling remains a powerful strategy to promote behavior change and advance health equity.