Getting Graphic

When the National Kidney Foundation was looking for a more effective way to educate patients about the challenges of dialysis, they decided to take a unique approach: They created a graphic novel to achieve their desired results.

Bob Brown

Graphic novels, the combination of a comic book and a novel, have come a long way since first appearing in the 19th century. In 1986, Art Spiegelman's graphic novel Maus won the Pulitzer Prize for literature. More recently, Hollywood has adapted numerous graphic novels into films. Today, the genre has entered the medical marketing and education world as a potentially excellent tool to communicate a message.

Why Go Graphic?

Graphic novels communicate more clearly, simply, and effectively than many other communication vehicles. As a result, they reach diverse audiences, adapt to multiple media, and make complex ideas simple.

The graphic novel can appeal to almost everyone from kids and adults to consumers and professionals. They communicate to any and all reading levels—from far below average to the most sophisticated. The "pictographic" nature of the graphic novel even makes it one of the few tools that can reach the non-reader. The graphic novel appeals to people who have no access to, or no interest in, a computer. Yet the genre also can adapt to a rich, interactive experience that appeals to the most avid computer user. And in a graphic novel, traditional rules can be broken. For example, people don't have to be black, white, or brown; they can be orange. That definitely redefines "diversity advertising."

The graphic novel can be printed—as a book, a series of comic books or comic strips, flyers, or posters. It can also be taped to the wall, handed out, mailed, projected at a meeting, posted on the Web, filmed for TV, or adapted for PowerPoint or keynote presentations. You get the versatile point! It can even be recreated "live" for special events. Furthermore, a target audience can experience a graphic novel in virtually any setting. It requires no special equipment, laptop, or television. It can be read casually or studiously, in private or public. It can be an individual's personal experience, or shared.

In serial form, the graphic novel supports substantial character and plot development, plus the exploration of complex subject matter. Over a series, a graphic novel can introduce several characters in multiple situations exploring a wide range of issues. When a vehicle that was once perceived as escapist entertainment addresses intellectually and emotionally complex issues in a mature way, the impact can be powerful. A good graphic novel can illuminate a topic, change behavior, sell a product, and teach buyers how to use it (or sellers how to sell it).

Hope & Main

As a child, you may have received small comic-style books from your doctor or dentist that covered subjects such as vaccinations, hygiene, or toothbrushing. These were forerunners of the graphic novellas being implemented today in medical marketing and education. Two examples stand out as major milestones—one from the 1990s and one that launched over a year ago and is currently running nationally.

In the '90s, the New York City Health Department developed a black-and-white comic strip series called Decision that followed characters dealing with HIV. The strips initially appeared in subway cars, and then were compiled into comic book form for handout. When the third issue invited readers to suggest the next events in the evolving story, the health department was inundated with suggestions. After several more issues, the health department decided to stop making Decisions, but it became regarded as a breakthrough in new applications for the graphic novel form and remembered as a very effective campaign.

In 2007, the National Kidney Foundation developed a graphic novella called Hope & Main, the "first reality series of, by, and for the dialysis community." Hope & Main serves as a centerpiece of an ambitious multimedia campaign. A pharmaceutical company funded the first year (six installments) of Hope & Main with a non-restricted educational grant. Their goals were to 1) support a unique solution to the need for "pictographic" education about dialysis issues, and 2) strengthen the company's marketing position in the dialysis community.

The following steps were taken in the development of Hope & Main. They serve as a primer for the creation of anygraphic novella:

1. Start with research

Extensive research and firsthand experience of the National Kidney Foundation showed the need for a "pictographic" solution. While the numerous multimedia tactics of the Foundation are effective with professionals and many patients, a significant share of the patient audience is unable or unwilling to use the Internet, resistant to most print materials, and unreceptive to educational DVDs—in fact, unreceptive to most of today's media mix. They need information in more visual form, independent of electronic media. The solution was to create a series of comic strips forming a graphic novel: Hope & Main.

Potential topics to cover were also researched before creative development began. Advisors—professionals, patients, caregivers, and members of the National Kidney Foundation team—contributed ideas regarding the most critical issues facing the dialysis community, the role of each professional on the multidisciplinary treatment team, the various types of patients in a dialysis center, and their most pressing concerns.

2. Begin writing

The creative team behind Hope & Main crafted a "story bible," just as creators of a television show do. They wrote "back stories" for each character (information that may never appear in the actual novel but helps the creators make characters more credible). They also created a full script for the first installment of the novella, plus outlines for five more—to demonstrate a firm grasp of the subject matter, to show the development of the Hope & Main characters and plot lines, and to prove that the concept can sustain interest over a series.

3. Illustrate

After determining the preferred style of rendering the characters, the novella's palette, and other visual details, the team screened artists—dozens of potential candidates—before finding the right one. Working with the artist, they went through numerous sketches and revisions of renderings of each character to achieve the right look in "personality," age, wardrobe, and other details. With a total of 10 characters—five patients and five professionals—each had to be clearly delineated.

Throughout, the editorial board reviewed sketches and final renderings of each character, as well as the script. The first Hope & Main came together in the form of black and white rough sketches organized into panels. These were reviewed and revised before text was added.

The entire team of collaborators, including the editorial board, reviewed the next version. Numerous changes were made in text and illustrations before creating a full-color version. Once again, more changes were made to both the illustrations and text. Once finalized, the novella was produced (and even translated into Spanish!)

4. Create a comprehensive campaign

The Hope & Main team also developed ancillary programs supporting the novel:

» A Web site for professionals, patients, and caregivers

» A bimonthly professional journal and patient newsletter ads announcing each new issue

» A direct mail campaign featuring the graphic novella's characters

» Email alerts to professionals and patients for each issue

» "Fax blasts" to professionals

» A learning aid that details the educational messages of each installment for patients

» A teaching aid with each installment for physicians and allied health professionals

» An exhibit booth for major meetings that target professionals or patients

5. Follow up

Multiple feedback forums are in place for Hope & Main: online discussion groups, focus groups, mail surveys, and more. Consumers and professionals have weighed in with praise, criticism, and ideas. Receiving feedback (and reporting it to the creative team and editorial board) is a daily activity. Audience members have suggested enough plot lines and topics to carry the program through the next decade, if feasible.

What's Next?

The success of the Decision and Hope & Main campaigns demonstrates how a graphic novel can engage a wide range of audience members. Today, graphic novels serve as a medium for branding campaigns, as a sales training tool (to depict sales situations traditionally addressed in "role-playing" exercises, for example), and in many other applications.

So the next time you need to motivate or educate, just go graphic!

Bob Brown is a founding partner of bryantBROWN communications. He can be reached at bob@bryantbrown.com