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Introduction Comic books and graphic novels have been used in health education. The youth of migrant and seasonal agricultural workers are highly vulnerable to the health hazards associated with agricultural work and the migrant workers’ itinerant home environment. Method The purpose of the study was to create a bilingual, culturally specific educational comic book to inform families of safety issues in youth hand-harvesting agricultural work and provide anticipatory guidance safety tips for agricultural work camp residence. In a mixed-methods design, a multistate and multidisciplinary team used focus groups to obtain the voice of potential users regarding the strengths and weaknesses of the comic book prototype and scales on satisfaction, helpfulness, and usability. Results Focus group participants contributed constructive criticism to modify the prototype. Quantitative surveys found the comic book to be satisfactory, helpful, and highly usable. Discussion This report describes the steps in the creation of the comic book that can be used for health promotion education.

Japanese manga, which present dramatic and imaginative stories in comic book form, have a growing readership in Asia, Europe, and North America. We investigated depictions of tobacco and alcohol use in a sample of contemporary shōnen manga, which have a primary readership of males ages 8-18, but also appeal to young females and adults. Large number of characters were shown smoking cigarettes and drinking alcohol, especially males, adults, and those categorized as "good" characters. Compared to the shōnens' early chapters (initiated in 1990-2003, depending on the series), more recently published chapters (2011-2016) portrayed fewer characters overall using a tobacco product and fewer minors using an alcohol product. The later chapters also presented significantly fewer depictions of tobacco-related behavior, consumption of both beer and other/unknown alcoholic beverages, and alcohol-related paraphernalia. Antitobacco and antialcohol behaviors or dialogue were rare. These findings raise legitimate concerns about the influence of these depictions on young readers' beliefs, attitudes, and behavioral choices. Future research should explore whether those concerns are warranted, but in the interim, government agencies and watchdog groups in Japan should consider applying increased public pressure on manga artists and producers to curtail these depictions and to offer positive role models in their place.

This review presents the first detailed presentation of the parallelism between the Tuskegee Syphilis Study and the Captain America graphic novel 'TRUTH: Red, White and Black', published as a graphic novel by Marvel Comics in 2004 as a paperback, and then in 2009 as a hardcover. First written, published and distributed monthly in 2003 as pre-sequel seven comic book series to tell the story of the origins of the WWII superhero Captain America. In 2003, Marvel Comics chose to tell a 'very dark story' to explain the origins of Captain America, a half century after the initial introduction of Captain America as a WWII action hero in 1940. By detailing-for the first time-nine parallel aspects between these two storylines, this review demonstrates how Marvel Comics brought the tragic Tuskegee Syphilis Study story into the popular press, thus reaching an audience far beyond traditional bioethics academicians. This review is intended to stimulate and guide classroom discussions on the ethical issues at the core of the infamous Tuskegee Syphilis Study allowing bioethical issues to be made more accessible to the general public, via school curriculums, by the use of graphic novels.

The authors investigated student satisfaction with the use of comics as an educational tool in clinical medical education. Students on a Psychiatry clinical clerkship reviewed educational comics at the time of orientation. End of clerkship surveys were utilized to assess students’ perceptions about the usefulness of comics for their learning during the clerkship. Students’ responses were qualitatively and quantitatively analyzed. Eighty-four percent of students indicated that comics helped improve their understanding of clinical concepts, while approximately 80% felt that reviewing comics prior to each clerkship rotation helped ease transition into their assigned clinical service. Almost three quarters of all responders (74%) indicated that they were more likely to review preparatory material in comic form, as compared to other formats. Students found the comics easy to read, fun, and appreciated the concise presentation of information within them. Students also highlighted the limited amount of information presented as a relative weakness of the program. Comics may be utilized as an acceptable educational tool in clinical medical education.

Socio-cultural rigidities regarding the shape and size of a woman’s body have not only created an urgency to refashion themselves according to a range of set standards but also generated an infiltrating sense of body dissatisfaction and poor self-esteem leading to eating disorders. Interestingly, through an adept utilisation of the formal strengths of the medium of comics, many graphic medical anorexia narratives offer insightful elucidations on the question of how the female body is not merely a biological construction, but a biocultural construction too. In this context, by drawing theoretical postulates from Susan Bordo, David Morris and other theoreticians of varying importance, and by close reading Lesley Fairfield’s Tyranny and Katie Green’s Lighter than My Shadow, this article considers anorexia as the bodily manifestation of a cultural malady by analysing how cultural attitudes regarding body can be potential triggers of eating disorders in girls. Furthermore, this article also investigates why comics is the appropriate medium to provide a nuanced representation of the corporeal complications and socio-cultural intricacies of anorexia.

Rising levels of severe obesity among children, worsening disparities by race and ethnicity and reluctance of primary care clinicians’ to provide obesity management to children are compelling reasons to consider alternatives to primary care management of childhood obesity. The Students Nurses and Parents Seeking Healthy Options Together (SNAPSHOT) trial will test the efficacy of an elementary school-based, school nurse-led, healthy weight management program to reduce excess weight gain among children, 8- to 12-years old with a body mass index (BMI) ≥75(th) percentile, by increasing healthy dietary practices and physical activity and decreasing sedentary behaviors. SNAPSHOT has enrolled and randomized 132 child/parent dyads to either the: 1) 9-month SNAPSHOT intervention that includes four home visits, 14 kid groups held during outof-school time and five parent groups or 2) a newsletter program consisting of monthly mailings and family-focused healthy lifestyle information. Outcomes are assessed at baseline, 12-months (post intervention) and 24-months (follow-up) post randomization. The primary outcome is child age- and gender-adjusted BMI z-score. Secondary outcomes include child dietary intake assessed with 24-hour dietary recall interviews and accelerometer-measured activity levels. The SNAPSHOT intervention is a model of secondary obesity prevention for children that addresses the urgent need for theory-informed, evidence-based and safe weight management programs, delivered by skilled health professionals in accessible settings. This report describes development of the SNAPSHOT trial, including recruitment and randomization procedures, assessments, intervention and implementation plans, and baseline characteristics of the study sample.

Comics have always responded to pandemics/catastrophes, documenting the way we deal with such crises. Recently, graphic medicine, an interdisciplinary field of comics and medicine, has been curating comics, editorial cartoons, autobiographical cartoons, and social media posts under the heading "COVID-19 Comics" on their websites. These collected comics express what we propose to call covidity, a neologism that captures both individual and collective philosophical, material, and wide-ranging emotional responses to the COVID-19 pandemic. Treating such comics as the source material and drawing insights from theorists Ian Williams, Alan Bleakley, Susan Sontag, and others, this article examines graphic medicine's representation of the COVID-19 pandemic. The conceptual metaphors of war, anthropomorphism, and superheroism are used to represent and illustrate the lived experience of the pandemic, and the article investigates metaphor types, their utility, and motivational triggers for such representations. In doing so, the essay situates graphic medicine as a productive site that presents the pandemic's multifarious impact.

Researchers and artists reflect on the partnerships that have created career opportunities and forged a deeper public understanding of science. Researchers and artists reflect on the partnerships that have created career opportunities and forged a deeper public understanding of science.

International audience; Since the beginning of the year, the world's attention has rightly been focused on the spread of the Coronavirus Disease 2019 (COVID-19) pandemic and the implementation of drastic mitigation strategies to limit disease transmission. However, public health information campaigns tailored to children are very rare. Now more than ever, at a time when some governments are taking populations out of lockdown and youth are returning to schools, children around the world need to fully grasp the modes of transmission of the disease, the health risks, the scientific notions of the immune system, the value of barrier measures, and the progress of scientific research. In the context of the COVID-19 pandemic, comics can be very useful for communicating quickly and effectively abstract and important information to children who might be under the influence of a large amount of sometimes contradictory information. Conveying precise, reliable, and accessible information to children is key in a world overwhelmingly impacted by the outbreak. This should be the role and the responsibility of world health official leaders and governments in compliance with the United Nations Convention on the Rights of the Child. In partnership with mainstream medias, consortia of scientists, communication experts, and education specialists, it is urgent that world leaders engage children in this worldwide public health fight.

Comic books have been part of popular culture since the 1930s. Social activists quickly became concerned about the risk that comic books posed for youth, including that their content was a cause of juvenile delinquency. Dr. Fredric Wertham, a forensic psychiatrist, led efforts to protect society's children from comic books, culminating in multiple publications, symposia, and testimony before a Senate subcommittee on juvenile delinquency in 1954. During the course of his activities, and quite possibly as a backlash, comics started to represent psychiatrists and particularly forensic psychiatrists as evil, clueless, and narcissistic characters (e.g., Dr. Hugo Strange went from being a mad scientist to a mad psychiatrist). Clinical forensic psychiatrists who were not necessarily evil were often portrayed as inept regarding rehabilitation. There are very few positive portrayals of forensic psychiatrists in the comic book universe, and when they do occur, they often have severe character flaws or a checkered history. These negative characterizations are woven into the fabric of contemporary comic book characters, whether represented in comic books or other media offshoots such as films and television.

Conversations surrounding end of life and death can be difficult or taboo for some, meaning that matters of organ and body donation are not widely discussed. To Donate or Not to Donate? That is the Question! is a comic developed to raise awareness and challenge common misconceptions about donation by encouraging the publics to engage in informed discussions about the different options available. This case study proposes graphic medicine as an alternative method of presenting donation information to a public audience, and illustrates how the comic medium can communicate body donation information in an accessible and engaging way.

In low- and middle-income countries (LMIC), epilepsy still represents a significant health challenge. In the Bolivian Chaco, we have previously found high levels of stigma towards people with epilepsy (PWE) especially expressed by high school students. In order to increase the knowledge about epilepsy, we have tested a comic book-based intervention on a sample of high school students.The study has been conducted in the Bolivian Chaco region where two urban and two rural classrooms have been randomly selected. Students have been administered a knowledge, attitudes, and practices (KAP) questionnaire, and then they underwent a comic book-based educational program where they were randomly assigned either to an autonomous reading or a character interpretation methodology. The same KAP questionnaire has been administered after the teaching session and at a three months follow-up. Mean KAP scores at the baseline were compared with the after teaching and the three-month assessment.Eighty-three students with a mean age of 15.5 ± 0.9 years, of whom 38 (45.8%) males, were recruited. After the comic book session, students improved in the global score (p 0.001) and in the knowledge (p 0.001), attitudes (p = 0.004), and practices (p 0.001) subscores. Both the autonomous reading and the character interpretation groups significantly improved in the global score, but only the latter improved in all the subscores. At the three months follow-up, there were no differences in the global, knowledge, and attitudes subscores, compared with scores immediately after the intervention.Using a comic book to teach about epilepsy led to a significant improvement in the knowledge, attitudes, and practices about the disease in high school students of LMIC. This teaching strategy can be easily implemented in LMIC.

Objective: The purpose of this study was to assess the relationship between an embodied sensory experience and the ability to translate the perception of this experience visually using modifiable motion graphics. Methods: A custom-designed software was developed to enable users to modify a motion graphic in real-time. The motion graphics were designed to depict realistic visualizations of pain quality descriptors, such as tingling and burning. Participants (N = 34) received an electrical stimulation protocol known to elicit sensations of tingling. The protocol consisted of eight stimulation intensities ranging from 2-6mA delivered, in a randomized fashion and repeated three times, to the index finger. Immediately after each stimulus, participants drew the area of the evoked sensation on a digital body chart of the hand. Participants then modified the motion graphic of tingling by adjusting two parameters, namely the speed (rate of dots disappearing and re-appearing) and density of these dots in the drawn area. Then, participants rated the perceived intensity and selected the most appropriate pain quality descriptor. Results: There was an increase in the area, density, and perceived intensity ratings as the electrical stimulation intensity increased (P

The existing literature on leadership often describes it within fairly rigid gender roles. Entire models of leadership have been ascribed gendered labels. Shared leadership is, in traditional leadership theory, a feminine model. After observing a National Health Service (NHS) department enacting a shared leadership model, and using ethnography, grounded theory and comics-based research, we decided to explore the relationship between shared leadership and gender stereotypes. We realised our hope was to see a subversion of traditional stereotypes. Our data showed shared leadership overall as a feminine model, with its focus on distribution and compassion. Within the group, a range of gender roles were performed, meaning that the group could represent itself to the outside world as either more masculine or more feminine as required. This was beneficial, as conflict with outsiders was minimised and hence anxiety reduced. However, we noted that within the group, traditional gender roles were not subverted and were probably reinforced. Despite our view that shared leadership has not been an opportunity to resist gender stereotyping within this department, the success of this feminine model may represent a challenge to the prevailing masculine model of leadership within the NHS.

Increasing reliance on statistics for treatment and clinical risk assessment not only leads to the reductive interpretation of disease but also obscures ambiguities, distrust, and profound emotions that are important parts of a patient's lived experience of illness and that should be regarded as clinically and ethically relevant. Enabling critique of the limitations of statistics and illustrating their hegemonic impact on the patient's experience of illness, graphic medicine emerges as a democratic platform where marginalized perspectives on illness experiences are vindicated. Through a close reading of two carer narratives, Mom's Cancer (2006) and Janet & Me: An Illustrated Story of Love and Loss (2004), we illustrate how graphic pathographies represent experiential features of illness that are obscured by overreliance on statistical data.

Analyzing two harm reduction comics campaigns-one early in the AIDS crisis (the Gay Men's Health Crisis' [GMHC] 1980s Safer Sex Comix) and one more recent (Fabrice Neaud and Thierry Robberecht's 2008 Alex et la vie d'après), I explore tensions between queer safer sexual erotics and national discourses of sexual norms/deviation raised by Cindy Patton and William Haver at the height of AIDS discourse theory in 1996, approximately halfway between the comics. Using these theorists' reflections on the history of AIDS activism/representation as a hinge, I explore the manifestation/transformation a decade later of the ethical, educational, and erotic issues they raise. Both foreground the ways that HIV, safer sex, and/or eroticism pose difficulties for systems of linguistic and visual representation. Combining text and image, comics-a common harm reduction medium-epitomize this representational issue. While the GMHC addresses an immediate need for information about safer sex, Alex attempts to tackle the unrepresentability/unthinkability of safer and/or seropositive sex(uality). Safer Sex Comix, while largely prioritizing directness above formal experimentation, employ strategies of transgressing the borders of the comics panel to emphasize a plethora of lower-risk sexual acts. The most visually inventive moments in Alex represent Alex's feelings of unintelligbility post-diagnosis, but the comic restricts its representation of sex only to anal intercourse, and it proves unable to visualize alternative formulations of the erotic, turning to more normative narratives and images as earlier, visually explicit unsafe sexual encounters are replaced with more a/illusive representations post-conversion, literalizing the unrepresentability of seropositive erotic life.

The Life and Times of America Chavez was a comic book series eventually published in trade form. Written by Gabby Rivera, queer Latinx young adult literature author, this iteration of Marvel Comic's Miss America (America Chavez) possesses an awareness and authenticity of Latinx culture and lesbian identity that was nothing less than revolutionary. Joe Quinones's artwork, rich in color, spirit, and pride, underscored the need for Latinx voices (both visual and verbal) to tell our stories. In this essay, I provide both a scholarly view of AMERICA as a superhero tale and illuminate the experience of reading her as a Latina lesbian.

Cyberzone is a fitting place to start any discussion around Black lesbian identity in comics, as it is the first comic book that this researcher could find which features a Black lesbian female lead superheroine. Cyberzone was self-published by Jimmie Robinson in 1994 and later re-vamped into a mini-comic series called Amanda and Gunn with Image Comics. First, this article deconstructs Cyberzone through the lens of Cultural Prism Theory (CPT). Second, this article situates Cyberzone within the framework of CPT to address Cyberzone's place within the comic book ecosystem. Finally, this essay offers a close reading of Cyberzone, issues #1-#4, against the backdrop of the intersectional framework Black Queer Identity Matrix. During this process, the researcher demonstrates how Cyberzone is a powerful site of resistant cultural commentary.

This essay considers Diane DiMassa's 1990s comic book series Hothead Paisan: Homicidal Lesbian Terrorist alongside the recent rise and visibility of White supremacist movements following the 2016 United States election. While Hothead's acts of queer revenge primarily target White heterosexual cismen, several issues feature Hothead taking aim at neo-Nazis and the KKK. Exploring the way in which Hothead's relationship to debility and capacity is mediated by her gender, sexuality, and race, the essay argues that a biopolitical approach, including the recent scholarly turn to the non-human, can provide a useful framework for approaching interlocking systems of violence and oppression that go beyond traditional intersectional models of resistance.

This essay argues that we should judge the illustrations in a graphic novel (often a memoir) in the context of the entire work. Judging a work on its emotive effects and the values it expresses, we can consider the ways a graphic novel represents the experience of illness, disability, or injury.

Purpose This preliminary study developed a digital graphic novella targeting hearing protection beliefs of Spanish-speaking agricultural workers. Researchers used pretest–posttest interview surveys to establish if the novella had an immediate influence on the participants' beliefs about noise-induced hearing loss and usage of hearing protection devices. Method Researchers developed a digital graphic novella directed to increase knowledge about noise-induced hearing loss and increase the proper use of hearing protection devices. The novella was tailored to meet the specific linguistic and literacy needs of Spanish-speaking agricultural workers. Thirty-one Spanish-speaking farmworkers of Mexican nationality participated. This study included an interview survey with specific questions on noise-induced hearing loss, myths, and hearing protection device usage. A pretest–posttest design was applied to measure the graphic novella's immediate influence on workers. Results The posttest scores on Hearing Protection Beliefs statements were significantly better than pretest scores, with a large effect size observed. Conclusion Digital media may be an effective way to overcome language and literacy barriers with Spanish-speaking workers when providing health education and prevention efforts.

There are unaesthetic aspects in teaching people about the early detection of colorectal cancer using the fecal immunochemical test. Comics were seen as a way to overcome those unaesthetic aspects. This study used the Asian grocery store-based cancer education venue to pilot-test the clarity, cultural acceptability, and alignment of five colorectal cancer education comics intended for publication in Asian American and Pacific Islander (API) community newspapers. After developing the colorectal cancer education comics, API students asked shoppers to review a comic from their collection and provide feedback on how to make the comic clearer and more culturally pertinent to API readers. To evaluate viewers' responses, the students gathered such unobtrusive data as: (1) how many of the predetermined salient information points were discussed as the student educators interacted with shoppers and (2) how many comics the shoppers were willing to review. Shoppers were also asked to evaluate how effective the comics would be at motivating colorectal cancer screening among APIs. The students were able to cover all of the salient information points with the first comic. As evidence of the comics' capacity to engage shoppers' interest, shoppers willingly evaluated all five comics. Using multiple comics enabled the educators to repeatedly address the four salient colorectal cancer information points. Thus, the comics helped student educators to overcome the unesthetic elements of colorectal cancer discussions, while enabling them to engage shoppers in animated discussions, for far more time than with their conventional didactic educational methods.

Since the Vietnam War, graphic novels about war have shifted from simply representing it to portraying avenues for survivors to establish psychological wellness in their lives following traumatic events. While modern diagnostic medicine often looks to science, technology, and medications to treat the psychosomatic damage produced by trauma, my article examines the therapeutic potential of the comics medium with close attention to war comics. Graphic novels draw trauma in a different light: because of the medium's particular combination of words and images in sequence, war comics represent that which is typically unrepresentable, and these books serve as useful tools to promote healing among the psychologically wounded. Graphic narratives, both fictional and non-fictional, illuminate the ways that the unseen wounds of traumatic experience affect public health by compromising the ability of communities, individuals, and survivors to create and maintain meaningful relationships with others.

Word Choices is a mixed-media digital illustration that explores the importance of clinicians' word choices during their encounters with patients. Clinicians often face ethical questions about sharing information with vulnerable patients, dimensions of which are represented by the illustration's content and colors.

Grounded in analyses of two graphic memoirs, Ellen Forney's Marbles: Mania, Depression, Michelangelo and Me and Allie Brosh's "Depression (Parts Oneamp; Two)," this article draws from Sara Ahmed's 2006 book, Queer Phenomenology: Objects, Orientations, Others, in order to theorize the "queer phenomenology" of what gets called depression within many Western psychiatric, medical, and cultural discourses. Arguing that queer desires orient the subject away from (hetero)normative objects (or "happy objects," as Ahmed calls them, because they promise a life of happiness), Queer Phenomenology suggests that the subsequent turn toward queer objects produces feelings of dis-orientation in the subject. Noting the similarities between Ahmed's idea of queer disorientations and my own disorienting experiences of depression, this essay posits that depression similarly constitutes a turn away from"happy objects" andtoward objects which, through their newfound prominence in the depressed person's life, may appear as strange or even queer.

The present paper describes the story of the development of a graphic novel—a story about superheroes—written by adolescent cancer patients on the Youth Project at the Istituto Nazionale Tumori in Milan (Italy). Nineteen patients from fifteen to twenty-five years old (fifteen receiving treatment for their cancer, four who had recently completed their treatments) participated in a four month creative writing laboratory managed by a professional teacher. The output from the writing laboratory was a written text that was used as the script for a graphic novel drawn by professional cartoonists and working together with the patients. Through their story, adolescent patients succeeded in voicing their dreams and fears. It was the adolescent patients themselves who explained how they had each tried to bring out the superhero inside them. This project describes the amazing powers of adolescents with cancer and opens a precious window on their inner world, enabling us to gain a better understanding of what they are really thinking and feeling through their own words.

Representation of psychological experiences necessitates a creative use of means of expression. In the field of graphic medicine, autobiographical narratives on mental illness find expression through the unique semiotic nature of comics, which facilitates the encapsulation of complex psychic-scapes and embodiment of the artist’s experiences. In so doing, these verbal–visual techniques provide vividness and easily digested expression, translating the sufferer’s altered mental perspective effectively for the reader. The deployment of such elements inherent in the medium facilitates multilayered connections to the patient narrative, which provide a depth beyond the raw medical discourse. The present essay, with reference to Ellen Forney’s Marbles: Mania, Depression, Michelangelo, & Me: A Graphic Memoir and Allie Brosh’s Hyperbole and a Half: Unfortunate Situations, Flawed Coping Mechanisms, Mayhem, and other Things That Happened, investigates the mediative value of rhetorical devices unique to the medium of comics in actualizing the subjective experience of mental illness. The essay also seeks to delineate the cultural power of graphic memoirs by positioning them at the crossroads of sufferer’s experiences and clinical description, drawing on theoretical insights from George Lakoff and Mark Johnson and other graphic pathographers/theorists, such as Ian Williams and Elisabeth El Refaie.

For microbiologists, the importance of microorganisms in our daily lives and their impact on our well-being is evident. However, microbiology literacy in our society is far from being enough for individuals to make informed choices and to demand actions based on that information. The vaccine hesitation movement and the alarming increase in antimicrobial resistance due to overuse and misuse of antibiotics are just two examples of how much work is needed to make our society literate in topics related to microbiology. Considering the challenges of communicating a discipline surrounded by misconceptions, which studies the role of living organisms that cannot be seen in plain sight, we need to explore different strategies to effectively contribute to microbiology literacy in our society. Here, we will comment on the use of comics for such a task.

Background: Personal narratives have been seen as a useful way of communicating about cancer treatment options and providing recovery information. Many printed versions of such material are available, including comics that explore the individual memories of patients who have gone through cancer treatment. These studies have been used to orientate patients, patients’ relatives, and physicians. However, only a few Web-based comics have been specifically designed for patients with breast cancer and used as aids to decision making. Objective: We aimed to describe the developmental process of creating an animated comic as a Web-based surgery decision-making tool; the comic was aimed at illustrating the feelings, thoughts, and meanings when a patient suffers from breast cancer. This was done by recounting the symptoms, diagnostic process, treatments, and treatment effects of such women from the diagnosis stage onward. Methods: Using cycles of planning, action, evaluation, and reflection, which involved collaborative work, action research was conducted to develop a Web-based animated comic. The stages of action research consisted of (1) semistructured and in-depth interviews to collect experiences of women with breast cancer; (2) construction of an animated comic by editors, graphics designers, dubbers, and information technology engineers; (3) redrawing of pictures of the comic after gathering feedback from a breast surgeon; and (4) evaluation of the Web-based animated comic using 6 patient focus groups. Results: The comic was produced and showcased on the website “The Network of Making-decision Aids for Breast Cancer Surgery”; the comic was accompanied by soft music and audio explanations. The comic functions as a personal statement that describes experiencing breast cancer. The animated comic consists of 8 chapters, based on the 8 themes deducted from the findings obtained during the analysis of relevant interviews. The 8 chapters include (1) the appearance of a lump; (2) confirmation by medical diagnosis; (3) the uncertainty of waiting (4) fear of life-threatening disease; (5) choosing life over despair; (6) being brave and deciding to undergo treatment; (7) choosing the type of surgery; and (8) being reborn. Conclusions: Using action research, this study illustrated that the comic that sheds light on issues of feelings, emotions, and thoughts that are present when a woman is diagnosed with breast cancer and provides a communication medium to explain the steps in the process. Meanwhile, it implies that hope will be able to overcome the challenges that will be faced. Within the Web-based decision aid for patients with breast cancer, the animated comic acts as an information resource and is aimed at patients’ understanding of impacts of emotions arising when suffering from breast cancer. It is potentially applicable as a therapeutic tool that facilitates self-reflection and self-healing among newly diagnosed patients with breast cancer.

Background There is a growing body of international research that displays the prevalence and character of abuse in health care. Even though most of these studies are conducted from a patient perspective little is known about how patients conceptualize their agency in relation to such situations. This study aimed to explore how patients reason about their potential to act in abusive situations. Methods Qualitative interviews were conducted with thirteen patients in Sweden. Central in the interviews were three comics, inspired by Boal’s Forum Theatre and part of an earlier online intervention study in which the informants had participated. Each comic showed a situation in which a patient feels abused, and on the opposite side were suggestions for how the patient could act in response. Informants were asked to reflect about situations of abuse and in specific upon the comics. We used the methodology of constructivist grounded theory throughout the study, including the analysis. Results It appeared that the informants constantly re-negotiated their and other patients’ agency in relation to the specifics of the event, patients’ and staff’s responsibilities, and the patients’ needs and values. This process questions views of agency as fixed and self-evident, and can be understood as part of changing discourses about patients’ social role and possibilities to organize their care. Using a feminist theory of power we expected the informants to elicit instances of resistance to domination, which is central to the comics. While doing that, the informants also hinted at parallel stories of empowerment and less visible forms of agency in spite of domination. Conclusion The current analysis showed different ways in which the informants constantly re-negotiated their agency in potentially abusive situations. Not only did the informants engage in reflections about immediate responses to these untoward situations, they also engaged in thoughts about strategies that could protect them and counteract abuse in health care over the long-term. This opens up for future research into ways patients organize their care and identify threats and barriers to the care they need, which could be valuable knowledge for care quality improvement.