Communicating a Scientific Story

For 18 years, NCIS (Naval Criminal Investigative Service) has been one of the most popular television series in the United States. Each NCIS episode tells a story of investigators seeking to solve a mystery. During the early 20th century, a dentist named Frederick McKay investigated a different mystery: why people in some communities had teeth with brown stains. His findings set the stage for H. Trendley Dean, who began studying the epidemiology of dental fluorosis in 1931 (National Institutes of Dental and Craniofacial Research 2018).

Like the NCIS characters, McKay and Dean were relentless detectives. Their findings eventually spurred research trials in Canada and the United States, demonstrating fluoride’s ability to reduce dental caries. This early research can be told as an engaging and suspenseful story.

Vaccines and fluoridation are the target of misinformation (Armstrong and Naylor 2019). Public health organizations typically try to raise literacy or counter misinformation with fact sheets and other data-centric messages—an approach driven by the knowledge deficit model (Cook and Overpeck 2019). Yet simply disseminating more information does not necessarily combat widely held myths (Martinez-Conde et al. 2019). Storytelling offers the oral health community another option for engaging audiences and complementing the facts.

Storytelling is communication through a narrative describing the experience of one or more people during a series of events (Dahlstrom 2021). Human beings are intrinsically receptive to stories (ElShafie 2018). Research shows that storytelling can raise parents’ oral health knowledge (Heaton et al. 2018). Stories are easier for people to understand and recall than fact-centered information (Dahlstrom 2014).

Stories can improve oral health literacy. This is crucial to address oral health challenges, including the surge in human papilloma virus (HPV)–positive oropharyngeal cancers among males (UCI Health 2020). Years ago, after a television drama series aired an episode about a patient with HPV, the percentage of viewers who could correctly define HPV rose from 9% to 28% (Poitras 2019).

For some researchers, the use of storytelling to write an oral health study might seem to conflict with “the plural of anecdote is not data” mantra. However, data and stories need not be adversaries. In fact, incorporating stories into scientific writing increases an audience’s willingness to base its decisions on the evidence (Downs 2014).

Researchers often struggle to communicate their findings to policy makers (Lee and Belohlav 2014). One likely barrier is that most members of legislatures, parliaments, and other health policy-making bodies have never conducted research or worked in academia. Because policy decisions are frequently driven by values and not only evidence (Fadlallah et al. 2019), storytelling could make a study more accessible to policy makers and more relevant to their values.

There is no definitive template to follow for researchers who want to use storytelling. Although various studies have explored how stories have been used to advance health promotion (Guse et al. 2013) or carry out research (Sools 2013), the literature offers few insights on the ideal process (Rieger et al. 2016), framework (Sundin et al. 2018), or tenets (Saffran 2021) for using storytelling to report research. However, there are several techniques and caveats for authors to consider.

First, identify story elements that already exist and use these components to render an accurate, compelling story (ElShafie 2018). Engaging stories are characterized by conflict (Thompson and Kreuter 2014). This conflict should be established in the introduction’s initial sentences rather than with a mundane phrase such as “This study investigated whether . . . ” (Clemens 2021). In an oral health–related manuscript, conflict is best represented by one or more obstacles to optimal oral health, such as policy barriers, gaps in clinical knowledge, and cultural paradigms.

Authors are told that introductions should give readers “the background information needed to understand your study” (Springer 2021), but a storytelling approach also requires this section to build readers’ interest by articulating why the underlying issue matters. For example, a study exploring dental biofilms and the etiology of caries could have enhanced interest in the introduction by citing caries prevalence data on a national, regional, or global scale (Salli and Ouwehand 2015).

Good storytelling in a study manuscript would show why the topic matters to a variety of audiences (Lingard and Watling 2016), telling parts of the story that data might not tell. For example, a journal article about Canadians’ visits to hospital emergency rooms (ERs) for nontraumatic dental conditions provided crucial context by citing not only the cost of such visits but the wasted expense because most patients are discharged by ERs without addressing the underlying oral disease (Brondani and Ahmad 2017)—raising the potential for return visits. Researchers writing a similar article today might also note that such hospital visits are particularly troubling during a pandemic that places exceptional stress on ERs.

The traditional structure of a manuscript (introduction, methods, results, and discussion) need not change to integrate storytelling (Lingard and Watling 2016). Brief stories could be included in several of these sections. For example, a story in the methods section about a data-gathering challenge could strengthen transparency and demonstrate that limitations are being acknowledged.

Researchers who investigate issues of health equity are encouraged to engage the community early, seek input for the study design, and listen respectfully (Cooper 2021). An interesting story could emerge from such a dialogue. A brief story in the methods section could shed light on how the protocols or benchmarks were chosen, reassuring readers that the authors were respectful of the study population. Another approach could be inserting several brief narratives in the discussion section, offering perspectives from stakeholders who live in or care for the study population (Sundin et al. 2018).

Some research manuscripts present findings from focus groups or informant interviews that explore how attitudes influence health decisions. For example, a focus group could seek insights about parental attitudes that might explain why boys are less likely than girls to be vaccinated for HPV (Johnson et al. 2017). Excerpts of parents’ comments could be shared as vignettes in a manuscript, helping researchers to highlight attitudinal barriers to raising vaccination rates for boys.

While stories typically conclude with a resolution, researchers should not pretend that they have solved the problem at the center of their “story.” Even a null result in research can lend insights. Whatever lessons emerge, researchers can identify the mysteries that remain for others to explore about oral disease, its risk factors, and so forth. Indeed, this is an opportunity to demonstrate that science works by incrementally building a cumulative base of evidence (ElShafie 2018).

Moreover, some experts encourage researchers to prioritize storytelling that raises awareness of the scientific process rather than as a tool to convey specific findings (Dahlstrom and Scheufele 2016). A 2019 survey revealed that nearly one-third of US adults did not know that the scientific method is designed to be iterative, producing findings that are continually tested and updated (Kennedy and Hefferon 2019). By strengthening the scientific process, storytelling can enhance public trust in research findings (Dean 2009).

COVID-19 vaccine hesitancy offers an example of how storytelling could increase trust in science. Some of this hesitancy has been driven by fears that safety was compromised to speed these vaccines to the public (Gordon 2020). Telling a story about the decades of research on earlier coronaviruses might have diminished these fears. Prior research enabled virologists and vaccine experts to learn much about coronaviruses, their vulnerabilities, and how to exploit these weaknesses. In addition, multiple COVID-19 vaccine programs were launched within days after Chinese scientists published the virus’s genome sequence on the internet in January 2020 (Moore and Wilson 2021). These efforts gave vaccine developers a critical head start as the pandemic began. This is how science works: new knowledge enhances a foundation of knowledge. Instead of telling this story, public health leaders who appeared on American news media typically cited the newly developed vaccines’ efficacy and safety data; while important, these data did not rebut the “warp speed” concern. Award-winning journalist Dan Rather (2021) wrote, “The idea that these vaccines came out of nowhere is a failure of science communication with tragic results.”

Where can oral health researchers turn for additional guidance on storytelling? University-based researchers could consult with their schools of communication. Many of these schools offer graduate courses on storytelling (Boston University 2021) or have participated in health-related storytelling initiatives (Gayman 2021).

While storytelling can enhance the understanding and impact of research, it is not a replacement for facts or data. A senior official at the Aspen Institute offers lucid advice: “No numbers without stories, and no stories without numbers” (Miller and Jarvis 2020).