Bringing fictional characters to life: reflections on co-creating a comic book with members of the public.

There are growing calls for cancer screening to become more personalised by considering a range of risk factors, rather than a one-size-fits-all, age-based approach. The aim of this public involvement was to co-create a comic book about bowel cancer screening to be used as a visual elicitation tool in research focus groups with members of the public and healthcare professionals, as part of the At Risk study, to discuss their attitudes toward personalised bowel cancer screening, which would involve considering different risk factors. This article critically reflects on the co-creation process to develop the comic book, benefits and challenges, and some lessons learned to inform other researchers considering a similar approach. In total, ten public contributors (5 men and 5 women) from two public involvement networks participated in two successive online workshops to develop six fictional characters, two for each level of bowel cancer risk (low, moderate and high risk). This tool was then used in the At Risk study comprising five focus groups involving 23 participants, including members of the public (n = 12) and healthcare professionals (n = 11). The co-created comic book was a generally well-received research tool able to generate discussion about a complex topic, bowel cancer risk, in an accessible way. It was suggested that the comic book may also be extended beyond the research context to inform bowel cancer screening decisions and raise awareness of risk factors. Plain English summary: A national screening programme for bowel cancer was set up in 2006. This is offered every two years to people aged 60–74 in England and 50–74 in Scotland. Bowel cancer is the fourth most common cancer in the UK and the risk of developing bowel cancer increases with age. Smoking, alcohol, diet and lack of exercise also increase the risk. An individual can change their lifestyle to reduce their risk. But if someone has a history of bowel cancer in their family, or has had another type of cancer themselves, they are still more likely to develop bowel cancer. Certain ethnic groups are also at higher risk. There are calls to tailor the bowel cancer screening programme to each person's level of risk. This needs to be acceptable to those who are offered screening. In our study, we spoke to members of the public and healthcare professionals to find out their views on this. This is a complex topic, and we decided to create a comic book to help people understand the issues and encourage discussion. We worked with an artist and ten public contributors to create the comic book. We held two online workshops and presented the comic book at a network for different ethnic groups in our region. Here we discuss what we learned from this creative process. We focus on: diversity in the workshops; the purpose of the comic book; language and humour; visual style; developing the characters; the setting for the story; cultural sensitivity and stigma. [ABSTRACT FROM AUTHOR]