Using Composite Narratives in Oral Presentations: A Novel Method to Humanise and Disseminate Qualitative Research

Phase 1 Context and Positioning

As researchers will have made ontological and epistemological decisions prior to data collection, an awareness of this theoretical positioning is important and will inform the nature of the composite narrative. The composite narrative method is often associated with narrative inquiry (Chen et al., 2023) and phenomenological approaches (McElhinney & Kennedy, 2022), as these are suited to exploring lived experience. This storied approach has also been used effectively in grounded theory studies (Johnston, 2024). However, composite narratives can be used with most qualitative methodologies where the intent is to gain a deeper understanding of participants’ experiences. The study upon which the example is drawn was a qualitative descriptive study to inform a mixed methods project based on the pragmatic paradigm. Researchers influenced by pragmatism are driven to choose research methods that have the most utility for responding to the research question (Mayan, 2023). Key pragmatic tenets, for example, pluralism, the provisional nature of truth and the subjectivity/objectivity spectrum, are suited to health and nursing research that explores diverse human experiences and contexts with a focus on action to solve problems (Deering et al., 2021; Dolan et al., 2022). The pluralist approach to knowledge, through accepting different ways of knowing, provides space for the experiential knowledge of researchers, health practitioners and consumers/patients (Dolan et al., 2022). The studies that generate composite narratives must consequently demonstrate methodological coherence, explained as “congruence between your research paradigm; your ontological, epistemological, and axiological commitments; the theoretical orientation (or meta-theory) you choose; your methodology; data collection and analysis strategies, and so on” (Mayan, 2023, p. 67).

Several considerations informed the development of our composite narrative, including the original study’s context, status of the available data, theoretical positioning and aim. We began by reviewing the context of our qualitative descriptive study, which informed the understanding of a general practice nurse-led intervention to improve the social connections of older people. Authors of composite narratives may work with qualitative data that has already been transcribed and analytically coded (Willis, 2019). We do note, however, that this is not the only methodological approach. Smith and Sparkes (2009) provide a useful typology of narrative analyses that distinguishes between story analysts and storytellers noting that researchers can move along this continuum according to the purpose of their research. They describe story analysts as writers of “realist tales” whereas storytellers favour creative analytic practices more commonly associated with “written, oral, theatrical performances” (Smith & Sparkes, 2009, p. 282). In our case, the data had already undergone thematic analysis. Therefore, the data collection and analysis processes were reviewed to ensure that the true intent of the original data was understood (Pushkarenko et al., 2023; Willis, 2019). This included re-reading interview transcripts and a review of coding and themes. This process is important, as peer reviewers need to understand data analysis processes and that alignment is evident between the original data and the derivation of the composite narrative (Willis, 2019).

The sources of the data used to develop the composite narrative must be clearly stated (Tetzlaff et al., 2024). Developing a summary table of the themes and quotations to be included in the composite narrative was a valuable step in ensuring key points were captured (Supplemental File 1). Participant demographic information was also gathered in a table. While findings from all participants contributed to the narrative, direct quotes were drawn from 11 participants (5 males and 6 females). Our composite characters, Arthur and Olive, reflected the speech of their respective genders.

Finally, a brief description of the phenomena of interest, including the aim of the composite narrative, is essential. Close familiarity with the data will ensure that the aim of the composite narrative aligns with the data collected and analysed. Other authors who have constructed composite narratives refer to the “narrative thread” (Johnston, 2024; Johnston et al., 2023). The narrative thread is the backbone of the story and guides the writer to ensure the story stays on topic and presents a coherent yet concise summary. Our composite narrative sought to capture the phenomena of social participation of community-dwelling older people with chronic conditions and identify barriers and facilitators to social engagement.

Phase 2 Structure

Decisions need to be made about the structure of the composite narrative prior to any writing, such as deciding on a title, the length and format, whether the first- or third-person voice will be used, and if a single theme or multiple themes are included (Johnston, 2024; Pushkarenko et al., 2023; Wertz et al., 2011; Willis, 2019). The title for the composite narrative should convey to the audience “what is significant in the story” (Johnston et al., 2023, p. 118). Our title, “Getting older with chronic health issues is depressing”, captured the overarching view of participants about the impact of chronic conditions on older persons’ ability to remain socially connected. It used the words of participants to maintain meaning (Johnston, 2024). As our composite narrative was constructed specifically for a conference presentation, we summarised key findings in less than 1,000 words. The story can vary from a short vignette of 200–300 words to longer multi-chapter stories of more than 2,000 words (Pushkarenko et al., 2023). The text may be written as a composite first-person narrative (Johnston et al., 2023; Wertz et al., 2011), or alternatively as a third-person account (Pushkarenko et al., 2023; Willis, 2018). In our example, we used a third-person approach to preserve anonymity but simultaneously give voice to participants by using their direct speech, with all quotations drawn from the interview transcripts. The preservation of anonymity is illustrated effectively by composite narratives investigating United Kingdom politicians’ navigation of life and work (Willis, 2018). The participation of these politicians was conditional on anonymity, so Willis (2018) drew from multiple interview transcripts to create several composite narratives. Different personas were reflected in each composite narrative. For example, one story explored findings from experienced politicians while another reflected the views of participants who were new to parliament (Willis, 2018, 2019).

The themes included in a composite narrative also require careful consideration (Wertz et al., 2011; Willis, 2019). Authors must decide whether the story captures a single theme or multiple themes. For example, Johnston et al. (2023) produced 24 composite narratives from their grounded theory study which explored the experiences of secondary school students’ classroom interactions with their teachers and how these interactions communicated teacher expectations of students. Each composite narrative focused on a theme that was synthesised from multiple student transcripts, such as the theme “feeling smart” which depicted the research finding that “students respond to teachers with high expectations by becoming more confident in their academic ability” (Johnston et al., 2023, pp. 110–111). Johnston et al. (2023) make the important observations that there is no one method for the presentation of findings through a composite narrative, and researchers rarely describe how the story was constructed. Another example of the variability in the production of composite narratives comes from a study of hospital doctors’ well-being during the initial phase of the COVID-19 pandemic, with five personas generated from interviews with 48 hospital doctors working in Ireland (Creese et al., 2021). Each composite narrative aimed to capture the diverse issues that influenced doctors’ wellbeing (Creese et al., 2021). These studies illustrate that different structures can include the use of direct quotes from multiple participants to produce one complete story about the entirety of experiences; or multiple stories that focus on different elements of the data (commonalities and divergences; positive and negative cases) (Creese et al., 2021; Johnston et al., 2023). Given the context and time constraints, we chose to produce one composite narrative that summarised the key themes holistically.

Phase 3 Writing, Reviewing and Reflecting

The third phase of composite narrative construction comprised writing, reviewing and reflecting. The writing of the initial draft may be undertaken by a single researcher. However, depending on the size of the research team, subsequent drafts are usually refined through group discussion and review. Careful editing is needed to ensure the narrative thread remains consistent with the aim of the composite narrative. Cross-checking and moving back and forth from the text to the data summary table is crucial to remaining faithful to participants’ words, meanings and feelings. In our example, one researcher (CT) crafted the initial draft of the composite narrative. All research team members worked together to edit and refine the draft, with cross-checking against the transcripts and the summary table. Examples of mapping the composite narrative with themes from the data analysis are presented in Table 1. This information is provided in the interests of transparency and illustrates one phase of our audit process. Excerpts of the thematic summary from this qualitative descriptive study are presented as a Supplemental Table.

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Table 1.

Examples - Mapping of Composite Narrative Text to Key Qualitative Data Findings

Composite narrative text	Alignment with study themes
Arthur and Olive are in their mid-seventies and have been married for 52 years, they’ve lived in the same house in Oak Flats for that entire period. They’re pleased to still be together as in the study they recently participated in, almost 60% of participants lived alone.	Demographic characteristics of participants
They have one daughter who lives in Florida. A cousin recently set them up with Skype and Olive says: “I have contact with my daughter …on Skype every week, so I love that”.	Facilitators of social connection – Family contact and support
Arthur loves sport and was a championship golfer and lawn bowler. He has chronic obstructive pulmonary disease, ischaemic heart disease, arthritis, and diabetes.	Demographic characteristics of participants
He doesn’t play bowls anymore as he says: “I can’t walk the length of the green without getting out of breath”, so much of his day is spent in that armchair.	Barriers to social connection – Getting around
Olive says I feel for him “It sucks. You just can’t do what you want to do”.	Living with chronic conditions – Independence and identity
Arthur’s front lawn used to be his pride and joy and now he admits “I just get frustrated, … I can’t do some of the simple things. Or some of the simple things I do take twice as long, if not longer... Like I used to be able to go out and mow the lawn. Now I get somebody else to mow my front lawn.”	Living with chronic conditions – Independence and identity
Olive has hypertension, Parkinson’s disease, chronic obstructive pulmonary disease, anxiety and depression.	Demographic characteristics of participants
She’s frustrated as she struggles to stay mobile and keep her house clean. She used to love going down to the local shopping strip as she has come to know the shopkeepers well having lived locally for a long time, Olive says: “People stand there and want to talk to me all the time.”	Facilitators of social connection – Feeling part of the community
Arthur chimed in: “I’d lived around here a long time. I might go down to get a litre of milk and be down there an hour and a half, talking.”	Facilitators of social connection – Feeling part of the community
Arthur no longer drives, and they find it difficult to access public transport. Arthur and Olive don’t visit the club anymore and miss that social outing. Their social network is deteriorating rapidly as so many of their friends have passed away Arthur says: “we haven’t got any friends whatsoever.”	Managing diminishing social contacts – Social networks
Arthur confides that “…getting older with chronic health issues is depressing… When I’m feeling really bad, I just go to bed, and I may be there for two days…but that’s what happens when me legs start going on me, and this – lung business.”	The experience of loneliness – Impact on wellbeing

When the composite narrative is completed, it should be read aloud to check that the story flows, is within the time allowed for oral presentation and, most importantly, truthfully conveys the findings in a usable form. This process also provides an opportunity to ascertain if the composite narrative emotionally resonates with audiences. Researchers have many techniques and choices to help stories resonate. Richardson (2000) discusses the differing use of literary devices by disciplines and how writers may blend scientific and literary writing styles. Creative non-fiction with its mantra of “show rather than tell” (Smith et al., 2016, p. 66) uses rich description to generate an emotional response. Evocative representations of research, such as creative non-fiction, can increase the accessibility of complex ideas to broader audiences through arousing people’s imagination, activating memories and stimulating emotions with attention to style, plot and pace (Cavallerio, 2022). Researchers deploy various writing techniques including character development, imagery, using concrete details, dialogue, active voice and interior monologue, tone shifts, metaphors and similes (Caulley, 2008; Richardson, 2000). Evocative representations of research employ more vivid forms of expression and present findings from different perspectives. In the case of our example, through the characters and dialogue of Arthur and Olive we sought to recreate aspects of the lived experience of older people ageing with chronic conditions to evoke an emotional response, engage the audience on a deeper level and incite action (Smith et al., 2016). We reviewed our composite narrative with diverse audiences. Initially, it was presented to academics and peers, before subsequently being presented to audiences of practitioners, policymakers and consumers, particularly older people. Refinements to phrasing and oral delivery were made after every presentation.

Researcher reflexivity influences all forms of qualitative data analysis (Olmos-Vega et al., 2023). It is no different in composite narratives, which integrate the knowledge and interpretation of the researcher with participant voices (Wertz et al., 2011). Quality and trustworthiness were reviewed by diligently considering authenticity and transparency. Authenticity refers to our crafting of the story, the researcher must represent the data authentically and remain true to the sources’ perspectives (Wertz et al., 2011). For example, this includes how the composite narrative draws from the data (Apramian et al., 2023; Johnston et al., 2023; Willis, 2019), such as specifying “the number of sources referenced to construct each narrative” (Tetzlaff et al., 2024, p. 449). In the composite narrative presented, if views were gendered in the data, then this was reflected in the narrative. We demonstrated transparency by recording an audit trail (Johnston, 2024) and ensuring the study addressed the four dimensions of trustworthiness, credibility, dependability, confirmability and transferability (Lincoln & Guba, 1985). We recognise that more recent work demonstrates how this position on trustworthiness has evolved (Lincoln et al., 2011; Morse, 2015), particularly in the social sciences (Sparkes & Smith, 2009). What is crucial is to avoid “non-reflective adherence” to criteria without due consideration of the context and purposes of the research (Sparkes & Smith, 2009, p. 493). Our final composite narrative is provided in Figure 2.

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Figure 2.

Getting Older With Chronic Health Issues is Depressing

Benefits

A major rationale for featuring a composite narrative in conference presentations is that it humanises research. Wertz et al. (2011) argues that composite narratives can increase the visibility of the human qualities of phenomena, such as in her depiction of female adolescents and their experience of being overweight. This is important in health research as better health care may be facilitated by providing health practitioners with an embodied understanding of a condition or issue. Wertz et al. (2011) explains that using a composite narrative allows the reader to be closer to the phenomenon of interest. This ability to engage the reader personally offers a more humanising experience. Sanders et al. (2024) argue that narrative as a research methodology contributes to the formation of new knowledge by using storytelling to improve understanding of people’s human experiences.

Another benefit of using composite narratives to report qualitative findings is the ability to provide “complex situated accounts” of the phenomenon under study (Olson et al., 2023, p. 254). In conference presentations, there is rarely time to provide this detail. However, a composite narrative can illustrate aspects of real life, such as, in the example provided relating to Arthur and Olive (Figure 2), a sense of where they live. This detail can be provided, yet anonymity is still preserved as information that may be identifying has been removed through the synthesis of findings. In our study, many older participants were living with multiple chronic conditions which influenced their ability to engage socially. Previous research has identified how the lives of older people with impairments are negatively influenced by stigma as they are perceived to be at fault for failing to stay healthy (Raymond, 2019). Using a composite narrative to present findings protected participant anonymity by appropriately combining information that might be identifying, such as the details of participants’ chronic conditions.

Composite narratives provide an opportunity to amplify participant voices in conference presentations. In this paper’s example, we sought to champion the voices of older people with chronic conditions to understand their experiences of social connection. Johnston et al. (2023) also demonstrated this by using student voices to project key findings from their research in education. Interestingly, these student participants contributed to the generation of the research findings and construction of theory through for example, constant verification (Johnston et al., 2023). Another benefit of composite narratives is their potential to engage marginalised groups in the research process (Keen & Todres, 2007). Many cultures, including First Nations and culturally and linguistically diverse groups, have long histories of storytelling as a way of communicating cultural traditions and mores with successive generations (Weststrate et al., 2024). In Australia, Aboriginal peoples use yarning as a method of storytelling, and this has been adopted as a research practice (Bessarab & Ng’Andu, 2010). Marginalised groups may feel more engaged when research findings are presented to them through a composite narrative, particularly if Indigenous voices are privileged (Rieger et al., 2023).

We have argued that composite narratives provide an underutilised method for communicating qualitative research findings in an accessible format (Johnston et al., 2023). There is a capacity to generate empathy within diverse audiences of health academics, practitioners, policymakers and consumers (Wertz et al., 2011), which may increase engagement with findings. The complexity of research has been reported as a barrier to research-policy translation, and policymakers may not relate to the technical language of researchers (Ashcraft et al., 2020). Composite narratives provide a means of presenting findings so that they emotionally resonate with the audience, and this can enhance the transferability of research findings (Johnston et al., 2023). Another advantage is their use in interdisciplinary research, as the composite narrative can increase understanding of findings among academics and practitioners from different disciplines (Johnston et al., 2023). The interdisciplinary origins of composite narratives and their flexible format enhances their usefulness across qualitative methodologies (Sanders et al., 2024).

Risks

There are, of course, limitations and risks in the use of composite narratives. A key risk is the oversimplification of complex findings. Willis (2019, p. 478) urges researchers to avoid a situation where “the narratives become simplistic or caricatured”. This is a risk if findings are selectively presented to create a stereotype of a group of people. Robust attention to demonstrating the link between the composite narrative and findings (Johnston, 2024), in addition to researcher reflexivity, are ways to mitigate this. Findings may also be oversimplified when the composite narrative is primarily descriptive and limited interpretation is included. Additionally, composite narratives may be criticised if it is perceived that there is a lack of theory to guide analysis. It should be remembered that the composite narrative weaves together findings that draw directly from varying processes of qualitative analysis.

One of the most frequently identified risks of the composite narrative method relates to the skills of the researcher (Olson et al., 2023; Willis, 2019). Willis (2019) refers to researcher burden and reflects on the pressure on the researcher to create an accurate and meaningful story that remains true to the data. In their composite narrative about racism on a university campus, Olson et al. (2023) echo this need for accuracy and meaningfulness and discuss the responsibilities of researchers to protect the anonymity of their participants. This risk was managed through transparently recording details of each team member, demonstrating their familiarity with the data and documenting how they move from the data to the anonymised narrative (Olson et al., 2023). The story that the composite narrative portrays will be inauthentic if the views of participants are not given primacy, so care must be taken when blending the voices of researchers and participants.