Abstract
This study examined students’ perspectives on the impact of an animated storyline surrounding the Sustainable Developmental Goals. Qualitative semi-structured interviews were conducted with students who participated in the storyline to gain insight on its impact on their learning experience. Results suggest that animated storylines can provide students the opportunity to express empathy toward individuals and communities facing global health challenges, recognize their positionality in relation to others living in different circumstances, and can encourage students to retain and apply the knowledge gained to global health projects. Through the results of this study, we illustrate how storylines might be used to enhance global health pedagogy.
Creating engaging and immersive experiences from storylines for the digital environment has been recognized as an educational learning tool within pedagogical practices, particularly within the realm of hybrid learning, which combines online and lecture-based learning methods (Hoban et al., 2013; Kickmeier-Rust et al., 2007; Yang, 2012). Storylines have been shown to help make learning more memorable and have the potential to provide real-world problems and apply the content learned (Novak, 2015; Rossiter, 2002). The terminology used to identify digital storyline animations varies in the literature, however, the definition centers around the concept of merging audio messages with tailored visual cues and graphics (Liu & Elms, 2019). It also often involves a narrated story embedded for the purpose of explaining concepts and engaging students in their learning experience (Liu & Elms, 2019).
Storyline animations within the health field have been implemented across multiple hybrid learning formats (Ahmed et al., 2015; Johnson et al., 2019; Li et al., 2013). For example, in a pilot study conducted by Johnson and colleagues (2019), online animated simulations were used as an educational tool for health care professionals to help foster cultural competency on poverty and food insecurity. Likewise, animated graphics were used in an electronic game that consisted of a storyline surrounding 10 topics about mental health literacy and piloted with undergraduate students to enhance mental health literacy for youth (Li et al., 2013).
There is sufficient evidence to demonstrate that including more technological learning methodologies into classrooms can lead to greater student learning experiences. For example, work done by Callaghan and colleagues (2011) looked at using innovative video resources to enhance postsecondary students’ knowledge of generic research concepts (including reliability, validity, and descriptive statistics) in paramedicine and physiotherapy programs. As part of this work, animated slides of definitions and analogical scenarios of concepts were shown. Students reported finding this resource extremely useful compared with using books and lectures, and expressed that the combination of audio and visual media benefited their learning expereince (Callaghan et al., 2011). Another study by Koch and colleagues (2010), examined the impact of providing narrated presentations and animated videos of course material to first year Bachelor of Nursing students, and results similarly and demonstrated it enhanced students’ learning (Koch et al., 2010). Much of the evidence and the literature support for storyline animations are grounded within various disciplines.
There is, however, a gap in the literature on the impact of animated storylines in postsecondary global health related courses. In response to this gap, our research question is whether there is an educational benefit to including web-based learning modules surrounding global health topics. Based on the potential impact that such interactive animated online modules could have on learning, we developed an animated storyline surrounding the Sustainable Development Goals (SDGs)—SDG Storyline, and made it available to students. The idea of our SDG Storyline project is reminiscent of the Global Storylines project run by the West of Scotland Development Education Centre, which focuses on making connections between stories and “real-world” issues (McNaughton & Ellis, 2016) to help participants develop skills to work together to tackle the problems they face.
The purpose of this study was to assess student feedback on the SDG Storyline to determine its impact on the learning experience of university students. Such qualitative assessments have been recommended for determining audience appeal, perceived impact, and improvements for animated storylines (Ahmed et al., 2015). Therefore, through qualitative semi-structured interviews with student participants, we sought to gain insights on the impact of the SDG Storyline modules on students’ learning experience, to better understand how such a pedagogical approach might contribute to the rapidly growing and broad field of global health education.
Method
Development of the SDG Storyline
The module contained two main parts: the animated storyline surrounding the SDGs and a quiz supplementing the animation. The animation was developed through VideoScribe software and the story centered on a family living in a fictional rural village in a developing country. The lives of the family and others in the village were showcased to include the typical challenges living in a country that might be ravaged with war, conflict, and poor health systems. Another key theme is the 17 SDGs, which were explored throughout the entirety of the storyline animation and how they relate to the fictional characters. The animation spanned approximately 15 min, with a 2 min introduction.
The web-based platform through which all the material was uploaded onto was created through the University’s main web delivery platform. Upon watching the 15 min animation clip, students also had the opportunity to complete an interactive quiz that was designed to examine basic comprehension of the animation as well as partake in application-based questions. Examples of application questions included giving the students a certain amount of money and having them choose what to buy for the family, while explaining their choice. Upon completion of the quiz, students were able to view feedback and received bonus marks in class worth 3%.
Participants
Interview time-slots and sign-up sheets were made available to each of the 59 students enrolled in a 3rd year Health Studies Course. A total of 53 students watched the video and completed the quiz and 10 students participated in the research study. The age range of students was between 22 and 26 years. There were a total of nine female interviewees and one male interviewee that ranged from third to fifth year of their undergraduate studies. All of them were enrolled in the Health Studies major program. Nine students had access to internet off campus and one student had access solely on campus.
Data Collection
The goal of the study was to investigate students’ personal experiences on how this module impacted their engagement and learning. The interviews included a questionnaire and face-to-face, semi-structured interviews, enabling diverse perspectives and detail of participants’ responses to be collected. The questions asked of participants included: What did you think of the web-based learning module regarding global health? Did the module have any impact on your learning? How did you find navigating through the module? Do you have any suggestions to add to the web-based learning module? The interviews were conducted on campus within the span of 3 weeks after the module was made available to students. Interviews were between 20 and 50 min long. All interviews were audio-recorded and then transcribed for data analysis to examine themes among the responses. All transcriptions were anonymized to uphold student confidentiality.
Data Analysis
Interviews were digitally recorded and transcribed verbatim. Researchers then coded the transcripts (i.e., systematic selection of a word or phrase to reflect the participants’ text) and conducted analysis. A software tool, ATLAS.ti3, was used for the analysis of the transcripts (ATLAS.ti, 2009). Codes were organized into broad categories under which sub-categories were created, along with descriptive properties, including relevant quotations. This process of coding helped to organize and interpret approximately 80 pages of interview text. A general inductive approach for analyzing the qualitative data (Thomas, 2006) was used, which requires researchers to construct theories and explanations based upon observations and interview data. These qualitative research methods were selected due to their strong potential to reveal complexity and capture the richness of collected data. In addition, the four-dimensional framework was used in evaluating the immersive learning experiences of the animated storyline (Freitas & Oliver, 2006). We selected this framework because our intention is to eventually incorporate this storyline into a game application in the future.
Ethics and Consent
Research Ethics Board (REB) approval was obtained for this study and consent from each participant prior to conducting these interviews. Throughout the process, participants were given the opportunity to withdraw voluntarily, at any time, and to pass on questions they were uncertain about or did not want to answer. It was made clear both in class announcements and on the consent form that participation in the interview portion was completely voluntary and decision to participate does not reflect on course marks or grades.
Limitations
Due to the context surrounding the nature of this interview, response bias should not be ruled out. Participants may have answered questions untruthfully, if for example, they felt a pressure to answer a question in favor of the researcher. Although coercion throughout this study was minimized, such as the instructor not knowing who participated in the interviews, anonymizing each participant with a participant identification code and addressing on the consent that the interview plays no role in their class mark, participants may have still felt the need or pressure to answer questions in a positive light. Second, as interviews spanned 3 weeks, it may have given opportunity for recall bias to occur if several participants watched the SDG Storyline and completed the quiz at approximately the same time but interviewed at different time points. Therefore, participants in the first week of interviews may have remembered details that participants in the third week did not. Finally, we acknowledge that we interviewed only 10 out of the 53 students who participated in the storyline. However, key findings were recurrent across the 10 participants, supporting their general relevance to the class.
Results
Three interconnected themes emerged from the analysis of the transcripts. First, the animated storylines provided students with an opportunity to improve their sense of empathy toward individuals and communities facing global health challenges and provided them with the opportunity to recognize their positionality with respect to others living in different circumstances. Second, the storyline helped provide students with greater perspective and helped situate their learning in the context of other courses and programs. Finally, the storyline encouraged students to retain and apply the knowledge gained from the SDG Storyline to course projects and global health problems. We provide details for each of these three themes in the following section.
Empathy and Positionality
Analysis of interview transcripts showed that students who participated in the study were better able to empathize after having the opportunity to recognize their positionality with respect to others living in different circumstances. As one student noted, The animation filled a lot of gaps in my imagination. Because we hear a lot about third world countries, but we don’t really, I guess, walk through it. And it [SDG Storyline] kind of did that, in a sense. It gave me more perspective on people living in poverty. So that was really good; like when she had to choose between the food and the kerosene for the lamp. I don’t know how to explain it, but you’re able to empathize . . . usually when you learn, you learn, but this kind of gets you emotionally involved as well. (Participant 7)
This idea of empathy was echoed by another student who said, “I mean it did make it more personable and made me empathize and sympathize with the people affected . . .” (Participant 8).
Other students reported that the SDG Storyline made it possible for them to put themselves in the position of others. For example, one noted, It actually impacted me very much, because I didn’t actually immerse myself into these types of situations. But after watching a video like that, and watching what people go through, it gave me a different perspective on it. And not a lot of people actually go through stories like that, so they don’t know how valuable certain things are like water, hygiene and sanitation. So just by watching a video like this, they gain that experience in a way, or understanding, without actually experiencing it. And you can relate to the characters a bit. (Participant 3)
In the comment above, Participant 3 highlights the importance of simulated experience in helping students with their learning and gaining a good grasp of the specific conditions of the social situations of the characters. Students also became aware of how their positionality influenced how they approached the interactive questions in the SDG Storyline as participants had to decide the best paths for dealing with certain challenges in light of constrained resources. Participants found it interesting as they realized how their previously held views and values influenced their decisions. For example, one participant noted that it was, “really eye opening to see how much more the gas can affect their lifestyle. So, it was eye opening in the fact that I didn’t see things that I was supposed to see” (Participant 9).
Another participant remarked that, “it’s like you’re building a personal connection but the story itself has a personal feel to it so that . . . any information that I got from it, I remembered it, for the most part” (Participant 1). Other students could relate with the struggles depicted on a personal and familial level. For example, one participant spoke about similarities between her family and certain characters in the storyline: I always learned about the struggles of my family members walking home late and alone from school. I mean I can’t really connect with Raina [a character in the story] because I haven’t personally experienced what she has, but I know what it’s like because my parents always tell me about what they went through, and it makes me feel sorry for Raina. (Participant 5)
These comments from students show how the storyline provided a connectedness to the character(s) within the animation and elicited a sense of empathy from participants as they recognized their positionality with respect to others living in different circumstances.
Perspective-Taking and Context
The second theme that emerged from these findings was that this animation provided a sense of different living perspectives. Some students reported that being able to view different perspectives of the different family members provided a greater understanding of the challenges faced within this story. This was made evident by one participant explaining that, It didn’t . . . just focus on the little girl Raina [a character in the story], . . . but it focused on, like, different levels so it’s like you see how it affects her mother in that situation; you see how it affects her father; and you see how it affects like her brother and it’s like you see these different perspectives of how the challenges in the village affect different people at different demographics, that’s amazing. (Participant 1)
In another example, a student remarks “I think we learn all these new topics . . . but we don’t really get to put ourselves into their shoes a lot . . . So, you get a personal perspective” (Participant 3). Hence, for this participant, being able to put themselves in the types of situations shown within the animation also connects with the idea of him gaining perspective on the struggles that others face. The participant goes on to say, . . . the girl Raina, she likes education . . . we take education for granted, but we see others like her don’t. So for education, we take it for granted, but others have to work hard for it and they’re denied it, so that’s kind of a bad thing . . . It just put a perspective that we take a lot of things for granted. Cause we live very comfortably now in this country, but in other places, it’s just not so safe and a lot of bad things happen. (Participant 3).
Students also remarked how new insights about global health emerged from participating in the SDG Storyline and it was “really eye opening” (Participant 9) and helped provide greater perspective.
Specifically, students showed they were able to understand different perspectives of personal versus institutional level issues which overall had an impact on the characters within this storyline. For example, one student describes some of the multiple plots going on in the storyline: I think at the beginning they were talking about how the son had to leave because he joined the army, and I think there was a lot of switching between personal level issues and institutional level issues. So, individuals, then international relations with NGOs, then individuals again, then the government and war. (Participant 4)
In addition, participants explained that the video animation helped provide more context in connecting the animation to lecture and textbook content. Specifically, one participant described, I like to connect things visually to what we’ve learned in the textbook and throughout lectures. So, just by watching that video, you’re able to relate to some of the themes or some of the topics that were discussed in the textbook. (Participant 10)
Another student indicated, I liked the story. It was really interesting, and it put things into context with my other courses as well, because some of my other ones are going over poverty and equity, and how it relates to obtaining better health. (Participant 6)
As another student put it, In terms of understanding global health concerns and concepts, I’d say it did give me a bit more food for thought and in that sense it reminded me again . . . why I entered into my massive programs [health studies] to begin with. (Participant 2)
One student offered a suggestion that would help students further understand different perspectives; she remarked that she would have liked to know what other students thought of the animation at certain situational viewpoints, and that an online class discussion around the animation could also provide further perspective.
Applies Knowledge
Within this final theme, participants reported that the animation helped them to retain and encouraged them to apply knowledge. Here’s one participant’s take, “I would say that the video itself was very memorable so whatever I watched from it, stays with you” (Participant 1). Another participant reported that the storyline animation provided an experience unlike his other classes which also left an impression on him. Specifically, he explained, I think at the end I’m able to take more away from the class than just doing like exams and whatnot, but I think like when I leave _____, I would have left knowing more information about the world and about different places in the world and their struggles, rather than just throwing out facts that like “one out of three women go through this” and I’d know that I would understand the reasons for those facts more so than remembering the actual facts, cause those will change, but like the determinants behind the facts aren’t/won’t. (Participant 2)
Several students noted the benefit of introducing this pilot study into senior level undergraduate classes, as it provided the opportunity to apply the knowledge learned from this module to the course and other classes. For example, one student explained that, It’s more beneficial because C level and D level classes tend to go more specific, and when you have more specific knowledge, you’re more likely to apply those skills to real life, as opposed to first and second year courses with a variety of different topics, so I think that’s why it’s [SDG Storyline] beneficial, because it gives you the actual skills you’d use in the future. (Participant 4)
Furthermore, this participant also noted that the animation gave them the opportunity to apply the SDGs to real-world situations and problems, noting that the animation encouraged them to “. . . know the goals more in detail and how they would apply in real life” (Participant 4).
Similarly, another participant explained the storyline animation provided an opportunity to test and apply the knowledge gained from this experience, compared with solely reading the textbook. Specifically, this participant said, The module was in relation to the SDGs, so it . . . helped me get a better perspective of the SDGs because I was able to apply and make connections between the two. Whereas, when I read the textbook, it didn’t really give me that opportunity; it just tested my knowledge and understanding, but not really my ability to apply the knowledge. (Participant 7)
Once more, the notion of how different themes come together to impact the learning experience is highlighted here because this participant shows how the animation provided a better perspective and allowed students to apply the knowledge learned from the animation.
Similarly, another participant discussed the aspect of applying what was learned from the SDG Storyline in solving global health challenges and making an impact in the field. This participant explained that the animation gave a clear understanding of the struggles within the storyline and to ask questions such as what can be done in the future. The participant explains that, I feel like the video really gave you an aspect of, okay, so this country is going through a lot; they need financial support and help with sanitation and etcetera, but what can you do about it? So, like, the video kind of gives you that thinking aspect like, okay, so now that you’re in this course and with the knowledge you have, what can you do about it in the future? Maybe start a company or something like that. (Participant 3)
Thus, the storyline animation provided students with the opportunity to think of how the knowledge learned from this module could be applied in real-life settings.
In addition to the inductive method, we used the four-dimensional framework (Freitas & Oliver, 2006) to evaluate the immersive learning experiences of the SDG Storyline. The use of the framework uncovered a number of areas for improvement which included the level of fidelity, interactivity, and interactions among student participants (Table 1).
Evaluation of the SDG Storyline Using the Four-Dimensional Framework.
SDG = sustainable development goals.
Discussion
The theme of empathy and positionality was common among respondents who shared that the animation paved the way for a personal connection to be built, helped them to empathize with the characters, and that overall the animation helped the knowledge gained to become memorable. Empathy formation within a learning environment has been proven to be beneficial to students. Being able to express empathy in certain situational contexts builds the ability to understand other people’s feelings, listen to others, and can even be found beneficial within the global health stream (Noddings, 2010). Specifically, when empathy is developed, it can be used to imagine what another person is experiencing. In turn, this makes communicating with others more fruitful and fosters dialogue (Ioannidou & Konstantikaki, 2008). In addition to this, a new concept relating to empathy is emotional intelligence. Emotional intelligence includes being able to understand and/or relate to the feelings of others to better help them. Howard Gardner in his book Intelligence Reframes: Multiple Intelligences for the 21st Century argues that human intelligence does not have a single format, and recognizes that the ability to empathize and sympathize aids to perceive the moods, feelings, and motivations of others. In turn, this impacts the overall cooperation and communication with others (Gardner, 2000).
The storyline enabled empathy and emotional connections with the characters because as students reported, they were able to put themselves in the shoes of the characters. As a result, they became emotionally connected and this provided an immersive and engaging learning experience. This is in line with a study done by Sadik (2008) which examined the impact of students creating their own digital stories (of class material) and presenting it to each other. Results revealed that watching other students’ creations led to a more engaged learning experience. Students reported these digital stories also increased their understanding of the curricular content (Sadik, 2008). Similarly, Liu and Elms (2019) created a series of animated videos regarding complex concepts of accounting that was provided as pre-lecture material to senior undergraduate students. Surveys collected from 254 students explored their experiences with the animated videos. Students revealed that these videos enhanced their learning experience as it increased engagement and interest in exploring complex course material (Liu & Elms, 2019). Another study by Kickmeier-Rust and colleagues (2007) examined the motivation to play and learn from educational games discussed that although difficult to create, immersive educational learning tools such as computer games can lead to a more engaged, satisfied, and effective learning (Kickmeier-Rust et al., 2007). Finally, Mystakidis and Berki (2018) created a multimedia eLearning educational tool surrounding history concepts which was presented to primary and secondary school students (Mystakidis and Berki, 2018). The project consisted of a virtual tour, an interactive digital storytelling activity, followed by a class hands-on-activity. During interviews with the teachers to review the success of this project, some described their students as being “captivated by the program and being quiet and concentrated as they went through the program” (Mystakidis and Berki, 2018). As such, creating storyline animations which have an immersive component brings a benefit to students’ learning experience.
Another theme that emerged from these results was how the animation provided students with greater context of different living situations. It provided them with perspective taking, which is an important life skill that leads people to build a greater understanding with others. (Engberg & Fox, 2011). Generally, virtual environments have been shown to generate person-centered perspective-taking (Lindgren, 2012). There is also increased perspective taking in other forms of interactive learning such as by web-based discussions held over internet platforms (Järvelä & Häkkinen, 2002).
In addition to perspective taking, another theme that emerged from the results was how the SDG Storyline inspired students to apply the knowledge gained. Within our study, students reported various accounts of being able to take the material presented from this animated storyline and apply it to their course work, and think beyond the classroom to real-world problems and how to combat them. The ability for digital online animations to help students apply the knowledge learned is well documented (Novak, 2014). Storylines seem to be an effective tool for student engagement inside and outside of the classroom. The use of audio visuals with storylines adds to the simulation experience and can enhance the satisfaction with the learning experience (Johnston et al., 2017). Furthermore, the use of fiction in storylines as was used in the SDG Storyline can be a valuable resource in education, as it provides the instructor the freedom to focus on specific themes or issues (Noddings, 2010).
Finally, transformative pedagogies like storylines can support constructivism and foster global citizenship (Hanson, 2010). Constructivism has the potential to provide a cohesive framework for education and learning in the health field (Dennick, 2016; Juvova et al., 2015). One feature of constructivism is the idea that students construct their own understanding and knowledge of the world through their unique experiences and reflecting on those experiences. Through the interviews, we observed insightful reflections from students about various issues as they related their personal experiences to the experiences of the characters. Storylines have been shown to provide a unique pedagogical dimension to Global Citizenship Education (GCE) and Education for Sustainable Development (McNaughton, 2014). There is a widespread adoption of GCE across the globe (Yemini, 2017) and there is growing recognition of its importance in global health education (Stoner et al., 2014).
Conclusion
As global health is essentially the blending together of various disciplines and professions along the journey toward health equity, these combined disciplines—which vary from medicine to economics and law—make for an extremely broad field. One aspiration of educators in the health field is to create educational interventions for undergraduates that can introduce them to the field of global health in such a way that they achieve a holistic perspective of the interdisciplinary nature of the profession. There are a variety of creative pedagogical approaches to global health education, such as the SDG Storyline, that can help achieve a holistic perspective. This article described the impact of the SDG Storyline from the perspective of undergraduate students in a university and the results suggest that storylines have the potential to play an important role in global health pedagogy. Effective storylines can provide students with an opportunity to improve their sense of empathy toward individuals and communities in global health challenges and provide students with the opportunity to recognize their positionality in relation to others living in different circumstances. It also provides them with greater perspective while encouraging them to apply the global health knowledge they have gained. The outcomes show that storylines can provide a unique pedagogical dimension to global health and contribute to the growing field of scholarship that is exploring how global health can be most effectively included in health education. One of the future directions for the project, as suggested by participants, is to provide viewers the ability to choose from various paths within the Storyline to make the module more immersive. By providing students with the opportunity to make major decisions within the storyline, essentially incorporating avatar characters, students would be able to navigate throughout the animation and hypothetically have a richer experience. It will be interesting to evaluate the pedagogical impact of such additions and what aspects have the most impact in providing students an effective and holistic perspective of the interdisciplinary nature of the global health field.
Footnotes
Acknowledgements
The authors are grateful to Adon Irani, Mark Mckee, Frishta Nafeh and Rebecca Ng for their support in developing the SDG Storyline project.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Teaching Enhancement Grant, Center for Teaching and Learning, University of Toronto, Scarborough.
