Educating marginalised adolescents about teenage pregnancy: How effective is a health-related photo story?

Purpose One way to improve health education, particularly to marginalised groups, could be to use photo stories: booklets in dialogic form in which photos and captions tell a dramatic story about a health topic. Unlike health communication in testimonial form, in which a narrator tells a story to convey a health message, stories in dialogic form feature characters who communicate directly with each other. Printed health communication in dialogic form, such as photo stories, is still largely unexplored research. We investigated whether a health-related photo story may be effective in educating marginalised adolescents in South Africa about teenage pregnancy. Design/methodology/approach A randomised controlled trial with three conditions (photo story, traditional brochure and control) was conducted among 174 predominantly IsiXhosa-speaking adolescents: 96 girls and 78 boys. Measures included knowledge, self-efficacy, behavioural attitudes and intentions, and readers’ preference. Findings Condition had a limited effect on topic-related knowledge. Girls in particular benefitted from reading the photo story in one respect: they agreed significantly less often with incorrect statements than girls who had read the brochure. On items about perceived self-efficacy, attitude and intention regarding “looking for support”, readers of the photo story scored significantly higher than participants in the control group, while readers of the brochure did not. Participants overall preferred the photo story to the brochure. Girls in particular were more positive about the photo story than the brochure as a tool for educating young people about teenage pregnancy. Research limitations/implications Future research should systematically investigate how narrative mechanisms, such as perceived similarity and identification, combined with topic relevance, influence the impact of health education materials. In addition, studies could explore variations on the photo story format, both in print and online, and compare them with other types of narrative and non-narrative health education tools in different cultural and literacy contexts. Practical implications The results suggest that both traditional brochures and narrative formats can contribute to positive effects of health education, provided they are well designed and tailored to the target audience. However, the findings also indicate that a photo story, a form of dialogic storytelling that combines visual information with recognisable characters and dialogues, can be particularly effective in promoting self-efficacy and positive attitudes and intentions. Health educators may therefore consider incorporating photo stories or comparable narrative formats into their communication toolbox. Originality/value This study is the first to compare a photo story and a traditional brochure on teenage pregnancy in an underprivileged community. It presents dialogic storytelling as a promising, underexplored approach in printed health education, expanding beyond testimonial formats and offering new insights for health education in low-resource settings.