Designing a Graphic Novel: Engaging Community, Arts, and Culture Into Public Health Initiatives

Abstract

The opioid epidemic was declared a national public health emergency in 2017. In Georgia, standing orders for the opioid antagonist, naloxone, have been implemented to reduce mortality from opioid overdoses. Service industry workers in the Atlanta, Georgia, inner-city community of Little Five Points (L5P) have access to naloxone, potentially expanding overdose rescue efforts in the community setting. To explore the issues facing L5P, our research brings together qualitative descriptive inquiry, ethnography, community-based research, a community advisory board, and a local artist to maximize community dissemination of research findings through a graphic novel that describes encountering an opioid overdose. This format was chosen due to the ethical responsibility to disseminate in participants’ language and for its potential to empower and educate readers. This article describes the process of working on this study with the community and a local artist to create sample pages that will be tested for clarity of the message in a later phase. Working with an artist has revealed that while dissemination and implementation for collaboration begin before findings are ready, cross-collaboration with the artist requires early engagement, substantial funding, artist education in appropriate content, and member checking to establish community acceptability altering illustrations that reinforce negative stereotypes. By sharing the experiences of actions taken during an opioid overdose in L5P through a graphic novel, we can validate service industry workers’ experiences, acknowledge their efforts to contribute to harm reduction, and provide much-needed closure to those who encounter opioid overdoses in the community.

Stayin’ Alive in Little 5: Application of Sentiment Analysis to Investigate Emotions of Service Industry Workers Responding to Drug Overdoses

“…The parent study employed bricolage, or purposeful mixing of qualitative methods [ 15 ], which included elements of ethnography, phenomenology, and grounded theory to describe the experiences of service industry workers who encountered and responded to an opioid overdose in a community setting. Service industry workers were selected due to their close proximity to community opioid-involved overdoses [ 13 , 14 ] and their documented conversion to default first-responders when encountering an overdose in the workplace [ 11 , 12 ]. The parent study utilized the engagement of a community advisory board, participant observation, criterion and snowball sampling, member checks, researcher reflexivity, peer review, triangulation of methods, constant comparison, and two independent coders to ensure interrater agreement of final codes and themes to ensure internal validity [ 16 ].…”

“…In response to the opioid epidemic in Georgia, more than 1000 units of naloxone, more commonly known by the brand name Narcan ® , have been distributed to residents and community members of L5P by the Georgia Department of Public Health and community advocacy organizations, such as the Atlanta Harm Reduction Coalition and Georgia Overdose Prevention [ 10 ]. Due to this distribution of naloxone in the L5P community, many businesses now have naloxone available in the workplace and service industry workers are now serving as first responders to overdose when it occurs by a community member in their workplace [ 11 , 12 ]. Restaurant and service industry workers are uniquely positioned to reduce preventable deaths by being prepared to respond to an opioid overdose.…”

(Graphic) Novel Approaches to Hazard Communication: Zombies and Beyond

“…Instead of a top-down, learn-from-our-graphic-novel approach, the process was an iterative collaboration between public health professionals, a community advisory board, service workers who had participated in overdose rescues, and an artist. 10 A similar process in the hazard communication arena might involve identifying a target audience (university lab students, for instance), making sure that they would be interested in a graphic novel, and then working with both an artist and a test audience of students to craft engaginging, informative material. This process has to include relevant science education for the artist.…”

“…Art meant to educate may in some cases be more expensive, as teams of artists, scientists, and test audiences work through multiple rounds of edits. Pages from the opioid comic book went through multiple rounds of edits to ensure that the science information was accurate (one panel had to be revised after the initial drawing showed a character performing CPR incorrectly) and that it could effectively engage audiences (making sure that all of the characters weren’t just thin white people, not particularly representative of Atlanta service workers) …”

“…A key step in that process was ensuring that the target audience was actually interested in comics. Instead of a top-down, learn-from-our-graphic-novel approach, the process was an iterative collaboration between public health professionals, a community advisory board, service workers who had participated in overdose rescues, and an artist …”