The future of storytelling for health

0:00Maya Adam:This is Stanford Engineering's The Future of Everything, and I'm your host, Russ Altman. Since we started this show eight years ago, it's become an archive of amazing and impactful work by my Stanford colleagues. Research is not something that just happens in the lab, and as you'll hear on this show, the research at Stanford can impact areas like health, technology, law, and business, and many other topics that can affect everyday life. We hope you'll tune in to learn more about how research has the potential to help your life and to help the lives of people you care about in your family and your community.

0:32Maya Adam:I think I've always been drawn to stories. I feel like they are the most powerful way to change people's minds. I have misunderstood things in the past and then met somebody who told me their story and fundamentally shifted the way that I see that topic area. So I always thought, you know, what if we can package this? the power of lived experiences of human beings who've, you know, raised a child, you know, who may be struggling with something that people don't understand. And let's capitalize on the beauty and the authenticity of that story and use it to open people's minds and then use that entryway to deliver evidence-based health recommendations.

1:30This is Stanford Engineering's The Future of Everything podcast. I'm Ross Altman. You know, we have some amazing episodes coming up, and you don't want to miss any of them. So please press follow on whatever you're listening to this on now to make sure you don't miss any episodes. Today, Maya Adam will tell us that she can spread evidence-based health information with beautiful, short, animated videos that tell a story that's globally accessible, sometimes without even words. It's the future of storytelling for health. Today, we're continuing our feature, The Future in a Minute. At the end of my conversation with Maya, I will ask her five questions.

2:05She'll give me five answers, and it'll take about a minute. Before we get started, please remember to follow so you don't miss any of the upcoming amazing episodes.

2:21So when we think about patient education, unfortunately, we sometimes think about things that are pretty dreary. Like you go to the doctor, they tell you about your medication or your disease, and they give you a pamphlet. And maybe you read it, it's usually not very inspiring, and maybe it changes your health behavior, but perhaps not. Well, what happens if instead, you could watch a short, high quality animated video, sometimes without even any words, that in an entertaining way, makes the exact point about your disease or about your treatment or your health practices that you need to learn.

2:57It's a memorable story. You take it away and that results in increased understanding and in changes in behavior that are beneficial for your health. That's exactly what my guest today does. Dr. Maya Adam is a professor of pediatrics and an infectious disease, and she's also a storyteller, artist, and media expert. She will tell us that she collaboratively works with health professionals who have an important message about some evidence-based health practice, like no sugar added to your food, or make sure you get these vaccines. And they can create these very attractive videos that can then be disseminated to try to change the health behaviors of patients for the better.

3:42To start out, Maya, how did you decide to combine your skills in storytelling and media with a message and a focus on pediatrics and in particular pediatric infectious disease in many cases?

3:57Maya Adam:Well, Russ, you know, I come from a bit of an unusual background. I spent 10 years on a stage as a professional ballet dancer before I studied medicine. And I realized in that career that even the most technically brilliant performers, if they were not able to touch the audience, to tell a story, to engage the audience, they became forgettable. And I realized when I moved into health education and health communication, that the same thing applied to our challenges. If we wanted people to listen to the health recommendations that we knew to be beneficial for them, we had to find ways of engaging them.

4:46So did you enter with health on your mind and then bring in the skills of media and storytelling? Or did you get the storytelling credentials, so to speak, and then say this is a good application area? How did you do that calculation?

5:02Maya Adam:I think I've always been drawn to stories. I feel like they are the most powerful way to change people's minds. I have misunderstood things in the past and then met somebody who told me their story and fundamentally shifted the way that I see that topic area. So I always thought, what if we can package this, the power of lived experiences of human beings who've you know, raised a child, you know, who may be struggling with something that people don't understand. And let's capitalize on the beauty and the authenticity of that story and use it to open people's minds and then use that entryway to deliver evidence-based health recommendations.

5:54It's such an attractive, what you just said is such an attractive model because so many of our medical colleagues, well-meaning and brilliant, they want to be about the facts and they want to be about logic. And they don't always realize that stories are what people, like the human mind is really wired to hear these stories and to remember them much more than kind of disconnected facts. And especially when it's something that you don't think about all the time or that requires a vocabulary that you might not have. And so that's what I wanted to get to next is how do you, well, I guess the first question How do you decide which topics are a good match to the media and the skills and the stories that you're able to tell?

6:35Maya Adam:You know, often people come to me, Russ. So our amazing colleagues at Stanford from every discipline, you know, many of them will approach me and say, do you think we could create a very scalable health message around this topic? And most of the time, even if I don't see it at first, most of the time I say, let's try. And then, you know, we work together to come up with a narrative that can be shown rather than told, because most of the media we create, we try and actually keep it wordless so that it can cross language barriers and literacy barriers. We then work with amazingly talented creative partners who come up with characters, if it's an animated film, for example.

7:26Maya Adam:And those characters, because of the beauty of animation is that we can create culturally accessible characters that don't necessarily look like a person in a certain context with certain demographic attributes. And so that allows us then to really start to imagine what we could tell and show in order to bring people into this topic. And then, of course, we make sure with the faculty specialists in those areas that we've hit on the main points that need to be shown in that video. And it becomes an entryway. It becomes a very light touch way to scale broadly, especially given the technology we have these days and the pathways through social media, for better or for worse.

8:21Maya Adam:We can use those pathways to disseminate messages to people where they are, where they're already consuming information rather than trying to get them to come to us. Yeah, and I do want to get to those, but I just have a few questions because I'm so curious about this. So you said that you almost always can give it a try. When things don't work, what are some of the reasons? Like my instinct is that maybe something is too technical and it's like, this is not, this is just too much details. But then you might also tell me, but you know what? We can put those details aside and figure out what the core message is.

8:57So I don't mean to be negative at all, but when it doesn't work, what are the kinds of things that make it not work? Or is that really so rare that there's nothing to say about that?

9:06Maya Adam:You know, we have not had a case yet where we absolutely could do nothing. Sometimes, in some cases, we've had to add script dialogue in order to make it clear. I'll give you an example. We recently worked with the German Cancer Research Center to create a very short film, animated film, to promote the uptake of colonoscopies and colorectal cancer screening. That's difficult to do, we found, without any scripted text. But we managed to do something very innovative where the main character is, in fact, a polyp. And, you know, and so it's just been it's been wonderful to walk that journey, especially with the Germans.

9:52Maya Adam:And, you know, we have these versions in German and in English. It makes it a little more complicated, which is one of the reasons why we usually lean towards wordless. But for example, we created a mental health series for the School of Medicine communications team, wanted to produce a series focused on basic mental health messages, promoting help seeking and those sorts of things. And one of our wonderful faculty members came to us and said, you're missing one piece of the puzzle, and that is addiction stigma, stigma towards people with addiction. If you don't have that in the series, it's missing something.

10:33Maya Adam:And that took me a moment because I thought, how are we going to do that as an animated short? It seemed so serious for me that I couldn't immediately picture it. And of course, sometimes when you sit with something, it's like a seed has been planted and an idea will sprout or you'll hear something. Someone said, made an analogy about fish and getting hooked on things. And I thought, that's our main character. It's got to be a fish. And we have to make it accessible in that way so that people don't turn away from this advice because it's too close to home. That really makes a lot of sense. And it leads me to my next question, which is about you referred to the universality of many of these short videos that you make.

11:21And does that happen naturally? Or do you have to think really hard? Like I could imagine that cultural standards, even what the background looks like, or what the cartoon character, forgive my phrasing, looks like, might make it very culturally specific. So tell me about how you get these to be as global and as universal as possible.

11:42Maya Adam:Absolutely. I mean, we've gotten better and better as we go along. But we one of the things that I think is a great asset is that we often work with creative team members who are based in other countries in the global south, for example. And because of that, we don't fall into a little bit of a trap of becoming sort of Western-centric in our visual approach. And we are very careful to make sure that we try and minimize those identifiers, socioeconomic identifiers, you know, location-specific identifiers. We try not to have references in there that would not work in many different parts of the world.

12:30Yeah. And it's wonderful. I did look at a few last night in preparing and they're very, one word is attractive. They're simple and they're attractive. So as you know, you're drawn to it. It captures your attention. And there's not a cacophony of visual and oral stimulation. It's just mostly like, okay, this is something I can pay attention to. And so I wanted to ask, before we get into some of the details, and there's these great stories, how do you know if something is working, right? So you put it out there, and then there's a big question about, well, first of all, are people getting the message accurately?

13:06And then second of all, is it leading to improved health? And I'm guessing these are not the easiest things in the world to measure. Absolutely.

13:14Maya Adam:And that's where I find a really exciting time now, because we are finally at a point in history when we have the technology, we have the scientific capability, and we have this innovative approach coming together to do rigorous science and measure the impact of these interventions. So, for example, for the video with the fish that was intended to reduce stigma towards people with addiction and encourage help seeking, we did a large scale online trial in three countries, in the US, the UK and South Africa, with more than 13 ,000 people. And because of the fact that we now have these online recruitment platforms, the representativeness has always been a question.

14:09Maya Adam:Are people on these platforms more digitally savvy, more connected than, let's say, the general public? But because our interventions are digitally delivered, they actually are a good proxy for our target audiences. And so we use these platforms to recruit large numbers of people, we randomize them, we use validated measures, as much as we can, to really parse out what's effective and what's not. And we've been able to publish these findings in journals that are highly regarded. So I think there's a growing acceptance, whereas maybe pre-COVID, this might have been seen as like unacademic to use stories to convey health information.

14:59Maya Adam:And I think COVID made us all stop and go, wait a minute, we need ways to get messages out to the world immediately. And they have to be accessible. And that gave us an opportunity to really jump in and show what we could do and then couple it with the rigorous science to actually document the impact of those interventions. Does this ever lead to an iterative process? So let's say you put it out, you do your testing and you say, oh, it's doing well, but it's not hitting on point A or point B. Do you then go back and sometimes revise? We do. We've often found over the years that we've been doing this, that attention spans are getting shorter and shorter.

15:45Maya Adam:So we've our content has become increasingly shortened and more condensed. We have also sometimes created videos where, you know, we thought it was a brilliant idea. And like, you know, some people who were hopefully going to disseminate it said, can't do that. And that's excellent because it's a learning experience for us of how far can we push the boundaries. I'll give you a little example of that. We created recently a very short intervention to raise awareness about smartphone overuse, so screen addiction in young adults. And we created it with young adults. And they were hilarious, Russ. They had ideas.

16:31Maya Adam:We were brainstorming. People were jumping up and shouting and drawing stuff on whiteboards. And we came up with this concept of visually showing smartphone addiction as being in some ways similar to cigarette addiction. And it's the film started off with a hook where there is a mother on a subway and she has a toddler and the toddler is screaming and she can't quiet the toddler down. And so out of her purse, she pulls a package of cigarettes. This is animated. OK, so. Yeah, yeah, yeah, yeah. puts a cigarette in the baby's mouth and lights it. And then everybody around her sort of smiles and nods their head approvingly.

17:16Maya Adam:And then after that, there's the analogy of the crying toddler and handing the cell phone and the child is quiet and everyone's happy. And so, you know, the advisors thought this would be a wonderful hook to get people to watch the video. And people love the video, but many dissemination pathways were closed for obvious reasons because we did not want to be accused of recommending that. Well, I mean, there you've done it. I mean, I knew this would happen, but you just told us a great story and you've told us a couple already and no one is going to forget that. That is fabulous. This is The Future of Everything.

17:55I'm Russ Altman and I've been speaking with Maya Adam. We've been up to now talking about the short animated stories that Maya and her colleagues make in order to have accessible, approachable, and effective short clips that help people understand health, health information gathering, health practices, and even about their disease or their treatment. I want to go to AI. It's a thing, and I'm sure it's affecting your world, even though you got started before it was a thing. And so I'm wondering, what has been the impacts in terms of both positive and negative on the way you think about your storytelling?

18:34I know that most of your early work was human-derived and human-animated. I don't know if that's changed. What's your relationship with AI, Maya?

18:43Maya Adam:So I'm cautiously optimistic about AI. I think there's huge potential there. Whenever we have an innovation like this in technology, I think there are a lot of people that are going to harness it and use it for good. And I hope to be one of those people. We are using AI for preliminary help with distribution ideas and those sorts of things. The one thing that I am not yet ready to hand over to AI is the creative component and the human component of what we do. because I think that the artistic part of our interventions and the stories, I believe that those need to be created and presented by humans.

19:35Maya Adam:So if I could ask, I'm sorry to interrupt, but we didn't actually get to this in the first segment. So all of the animations that you create, those are human animators who are creating it, artists? Absolutely. And in fact, it's interesting that you ask that because we're just about to launch a really exciting trial where we are testing a 100 % human created animated short film where the animation, the soundtrack, even the, it's an animated film that features a dance going on. Even the dance was choreographed and modeled by humans. And we're testing that against an intervention that is the same in terms of the technical components, but it is entirely generated by AI.

20:23Maya Adam:And we're going to see what the outcome is on psychological proximal indicators of individual and in some ways societal wellness. Things like moral elevation, the feeling that you get when you see somebody behaving in a way that is compassionate and courageous. And it makes you want to be a little bit better yourself. That's going to be our primary outcome. We're also looking at things like empathy and social connectedness. And we're going to see how these two versions of art affect people. And I think that's a fascinating question because the potential for me of AI is when it can reduce the burden on humans so that humans can do things only humans can do.

21:15Maya Adam:That's the beauty of it in medical practice where we now have ambient listening so that doctors can look at their patients and be those compassionate, caring physicians. It's amazing. It's like a killer app. Right now, it's the biggest killer app in medicine and it's such a simple idea, but it means we can look at our patients and not look at the screen. Exactly. So I am hoping that we can use AI productively, responsibly, and use it so that we can work more closely and more efficiently with actual humans who have human stories and human artistic inputs to share. So that is a very exciting trial.

22:00And I just want to ask a little bit about that. So are you going to tell the subjects, the participants who are being exposed to these videos, are you going to tell them anything about whether this is AI or human, or is that going to be latent? And you want to see if they sense that, oh, this seems a little bit more human than this one or vice versa.

22:19Maya Adam:They will not know which arm they're going to be randomized to. And only at the end of the trial, we're going to ask them if they thought the video they saw was generated by human artists or by an AI application. That's going to be fascinating. I love that. And it raises the issue that, you know, we're still learning if we have these human instincts about human generated material. I think we all think we do. Like historically, we say I can tell if something is real or fake. And I wonder, I know that you focus on medical messages. And it was amazing just to read my list that I was creating while I was reviewing your work.

23:03Addiction stigma, which you mentioned, flu hesitancy, COVID, transphobia, loneliness, added sugar to foods, nutrition and cooking. You've really focused on this amazing array of health related things. But it strikes me that there are a lot of other issues in the world where this storytelling approach might bring people together. And I don't know if this is like you're if you would say, Russ, I have enough with health. Give me a break. Or if you've allowed yourself to think about these methods of education and communication and what role they might have for the more general set of societal questions that come up.

23:40Energy, sustainability, other things that are kind of maybe aligned with health, but not directly health. Yeah.

23:49Maya Adam:I mean, I think everything we put out there, even if the primary focus is on delivering a health message, it also has a secondary impact in that hopefully it makes people feel something. And my hope is that with art created by humans, we are allowing for stories to be shared. And that involves, you know, where we come from, where we are today, who we hope to be. They're aspirational. My hope is that we can inspire a greater sense of social connectedness, which we urgently need right now, a greater sense of empathy towards others, because we see ourselves in the stories that they share, either through storytelling or through their art form, whatever that may be.

24:39Maya Adam:And I think, you know, we really can lean into that now more than ever to bring people a little bit closer together than we are right now. And it strikes me that your trial will be so important for the future of this effort. I mean, I don't think there really is bad news. Like, you know, we might find ourselves rooting for the humans. Like, I think I find myself rooting for the human and I'm a big AI guy. But let's say that we find that the humans are perfectly happy with both the AI generated content. That does create an opportunity for you, I would guess, to scale up, right? Because the AI, if it's good, it's probably going to be cheaper.