Infocomics vs Infodemics: How Comics Utilise Health, Data and Media Literacies

Abstract

During the COVID-19 pandemic citizens created their own artistic representations of public health messages. Tackling everything from the significance of R numbers, to being on guard for misinformation, these public health comics were shared across social media to thousands of followers. In this chapter we present findings from our UKRI/AHRC project ‘Comics in the time of COVID-19’ that analysed a sample of over 15,000 web-comics distributed on Instagram between March 2020 and March 2021. At their best, these comics amplified official public health messages, increased data comprehension, and led to more informed approaches to consuming and sharing digital media.

1 Introduction: The Rise of COVID-19 Comics on Social Media

During COVID-19 people’s pandemic lives became deeply entwined with public health information, from instructional hand-washing infographics, to calls to ‘flatten the curve.’ Alongside authorial graphics produced by the world’s biggest newspapers, the CDC, and the WHO, professional and amateur artists also created and shared public health messages online. These tackled everything from understanding the importance of rising R numbers to everyday public health behaviours such as how to effectively wear a mask and socially distance. In addition, these comics, shared across social media, covered a wide range of mental health and wellness topics, occasionally diving into broader issues of health equity and inequalities.

As U.N. Secretary-General Antonio Guterres warned, the world had to fight not only COVID-19, but “the growing surge of misinformation” (Lederer, 2020). Media literacy, in this moment, took on a public health role (see also McDougall et al., 2022), becoming situated at the intersection between fostering resilience to misinformation in general, and the immediate, exacerbated risk of exposure to misinformation on the virus. The widespread use of the term ‘Infodemic’ to describe the COVID-19 pandemic is a testament to this convergence. Social media researchers quickly spoke out about the possibilities - and perils - of public health communication over social media platforms like Twitter, Facebook, and Instagram (Chan & Purohit, 2020; King & Lazard, 2020). While some scholars noted that social media presents opportunities for health actors and governments to enhance data and health literacy by engaging millions of social media users, most research focused on monitoring and countering the flow of misinformation (Mendoza-Herrera, 2020; Johannsson & Selak, 2020).

Responding to this gap in the literature, our research study of ‘covid comics’ was designed to examine how social media platforms can be used to counter misinformation through the circulation of evidence-based and literacy promoting materials. Our aim was to offer insight into the roles that web-based comics can play for enhancing health, data and media literacies. By collecting, coding and archiving these dispersed digital artworks into a database, our project also set out to create a resource for developing health, data and media literacies, looking to improve creative, evidence-based media practices on social platforms like Instagram. In doing so, our approach utilises aspects of the ‘third space’ (Gutierrez, 2008; Bhabha, 1994), where existing, living literacies meet educational or developmental practices – in this case public health awareness. Resilient publics require conducive media environments which we can, subject to certain conditions, understand as third spaces. In these spaces, we can generate new knowledge about the potential connections between digital media literacy, communities, and public health—expanding the ways we imagine and utilise social media as a tool not only for countering misinformation, but for fostering health, data and media literacy through the creation of comics. Recent research into media literacy work in third spaces has developed a way of thinking about literacy of all kinds as dynamic rather than static (Potter & McDougall, 2016). This scholarship has generated a set of transferable design thinking and working principles for this kind of activity, themselves visualised in a webcomic (Rega & McDougall, 2021).

2 Intersections of Web-Comics and Literacy

Across different fields, research has repeatedly shown that comics can help increase the effectiveness of communicating and comprehending scientific, health and related data-based information (Hawley et al., 2008; Green & Meyers, 2010; Czerwiec et al., 2015; Ashwal & Thomas, 2018; Farinella, 2018; Noe & Levine, 2020). Comics can effectively communicate risk factors, as well as social issues surrounding an illness. Readers can relate to events and experiences, connecting them to their own and creating empathy (McAllister, 1992). Many comics containing public health messages that emerged during the pandemic fall under the umbrella term ‘graphic medicine’, a concept that emerges from the intersection of the comics medium and healthcare. The term was coined by Dr. Ian Williams, a GP, writer, and comics artist (Green & Myers, 2010) and Graphic Medicine is now an organisation that works to further the practice and provide resources for artists, educators, and healthcare providers alike.

The term provides an umbrella term to bring together a growing number of comics that engage with healthcare, illness, disability, patient education, treatment and patient experiences, and practitioner experiences. Works classified as graphic medicine cross a variety of comic genres, including webcomics, graphic pathographies, informational comics, comics strips, single panels, and video/audio installations. Dr. Alexandra Alberda, a graphic medicine scholar on our team, summarises the reasons for why comics can work well for science, health and data communication around three key principles: comics are approachable, accessible, and relatable.

• Approachable

  • Prevalent in popular culture

  • Created and read in many cultures

• Accessible

  • Medium used in literacy training

  • Iconography represents local/regional/national identities

  • Effective visuals can get closer to meaning than text

• Relatable

  • Tells the human-side of a health issue

  • Builds communities

2.1 Comics Are Approachable

The familiarity of comics as a medium makes comics approachable. Comics are also approachable as the reader has control over how long they engage with the work. As opposed to videos or television, comics allow us to process the message at our own speed (Karp, 2011). Comics may make people feel “more focused and in control” and “less isolated and more hopeful” through this individual pacing (Green and Myers, 2010).

This structural aspect of comics also contributes to its potential for enhancing data-driven storytelling. Bach et al. (2017) suggest that making use of panels can help break complex processes into less complicated units, helping guide the reader through transitions. For example, panels in a data-driven comic story might be used to zoom out from specific detail to the broader context, or conversely as a way of drilling-down from broader picture to smaller detail.

2.2 Comics Are Accessible

Comics are likewise accessible in that they are usually presented in an easy-to-understand format. They often connect with readers by employing iconography that has a local, regional, or national identity, using recognisable images that can often get closer to meaning than text can alone. Because of their familiarity and ability to make information more comprehensible, comics have been found to be a useful medium for getting information out to the general public (McNicol, 2016, p. 25). As Farinella argues by combining metaphors and character-driven narratives, comics have the power to make scientific communications accessible to a wider audience (Farinella, 2018).

2.3 Comics Are Relatable

The unique combination of text and images found in comics is also what can make the medium more relatable than other visual and text-based media. Not only is it important that health information is depicted accurately, but that patient and family experiences are also represented fairly (Green & Myers, 2010; McNicol, 2016). Through using emotive stories, people can forge stronger connections with health data, helping them to make sense of their own personal experiences with a particular issue or illness.

3 Research Method

Our research method involved a three-step process. First, we engaged with practices of web-scrapping to retrieve social media data for analysis. Web-scraping is a popular method of data collection for researchers using social media content, and to collect our sample, we used Apify’s Instagram scraper. While we originally planned to work with comics shared across different social media platforms including websites and twitter, we decided to focus on Instagram because of its visual prominence.

Bought by Facebook (now Meta) in 2013, Instagram is a for-profit, heavily commercialised platform driven by advertising revenue and the collection and sale of users’ data. Organised around the display and sharing of visual imagery, Instagram now has more than 1.3 billion users worldwide – accounting 22.6% of all people aged 13+ in the world. The platform has become an extremely popular mobile app, particularly among 18–34-year-olds, who make up 62.8% of its users (Kemp, 2021).

As the current leading platform for visual content sharing, along with its ease of use, Instagram remains a prominent choice for posting comics content and connecting with readers. The social media platform opens artists’ work up to new audiences through hashtags and the explore function. It allows artists to test out works in progress, gain immediate feedback from fans, connect with other artists, and gain commissions. During lockdowns, the importance of the platform for sharing work and connecting with audiences grew even more.

Our scraped dataset compiled 15,234 unique Instagram posts. Nine project team members worked to refine the original 15,234 dataset of Instagram posts to those that were ‘in scope.’ This was defined as posts that were comics in English that contained explicit public health messages. The refinement process left us with a sample of 3155 public health comics to code. These posts were then qualitatively coded by five project team members, after which we were left with 3130 public health comics.

Comics were sourced from just over 1000 unique users on Instagram; however, the distribution clearly resembled a long tail, with 20 artists contributing 25% of the total number of comics analysed. For data on visual and storytelling elements, we filtered out reposts, leaving a sample of 2340 original comics. Comics came from all populated continents. Of the comics with a clearly identifiable country of origin (just under 60% of the sample), nearly half came from the United States, with the UK at 15%, and India representing the third largest contribution with 8%.

While most researchers that use web-scraping methods aim to produce academic findings, our aim was to re-curate social media data to make this data differently accessible for content creators, stakeholders, and the public. To do this, we developed a process we call ‘coding as tagging’. Here we re-imagined traditional content analysis through the co-creation of ‘stakeholder folksonomies’ - categories relating to health and data literacy topics - that we then used, via coding, to ‘tag’ social media posts. This process transformed what would be a standard academic dataset into a searchable database that can become a publicly re-useable resource.

In the final step of our method, we directly contacted comics artists in our sample via an ‘opt-in’ participation process. This stage served to share project information and provided an opportunity for artists to self-represent by sharing biographical information and further links that we could include in our research dissemination. Together, these three steps offer an innovative, participatory approach to data-driven communications research.

4 Findings

In the next section of this chapter we look at findings from our study as they relate to (I) health literacy, (II) data literacy, and (III) media literacy in relation to creative social media practice.

4.1 Health Literacy

Existing research shows that using visual metaphors in comics can help facilitate the communication of complex health information and scientific concepts (Farinella, 2018; El Rafaie, 2019; Saji et al., 2021). Our study adds evidence to this argument, finding that visual metaphors were used in nearly one out of every four public health comics. Comics using of visual metaphors performed well in terms of audience engagement, as measured by like counts. Among the 10 most ‘liked’ comics tagged in the genre of ‘infocomics’ within our sample, 8 used visual metaphors. This suggests there is a relationship between the use of visual metaphor and engagement with public health messages on social media.

Visual metaphors are particularly useful when communicating health concepts that are otherwise invisible (Callender et al., 2020). For example, many artists in our sample drew COVID-19 as a monster or villain to visualise virus behaviour. This comic made by @elfylandstudios in collaboration with @lifeologyapp (see Fig. 8.1) features COVID-19 personified as a monster to illustrate the virus’ properties and behaviours for young audiences. Here, reimagining an abstract concept using familiar cartoon iconography helps to translate complex health information using a more recognisable visual language.

Fig. 8.1

Comic by Elfy Chiang in collaboration with Lifeology. Follow Elfy on Instagram @elfylandstudios

In the caption for this comic, artist Elfy Chiang writes, “This is a comic I made with @lifeologyapp and experts in virology. Created to help adults talk to little kids about the pandemic and help them make sense of the changes in our daily lives right now.” In a recent study, Saji et al. (2021) argue that such anthropomorphic metaphors “capture the existential experiences of the self and the bestial nature of the virus” (p. 152).

By depicting the virus as monster, comic stories can visually frame the ‘battle’ against COVID-19 as one that is collective and empowering, demanding society to fight the metaphorical beast. In our sample, one third of comics using visual metaphor also used elements from the superhero genre to depict their public health message. Superhero genre comics that clearly featured human characters battling the virus depicted mixed gender groups 40% of the time and mixed age groups 20% of the time. Even though, younger and mostly male depictions of superheroes follow the common stereotypes, the transgressive potential of comics can be seen in these comics that include mixed age and gender representations.

Comics can help communicate COVID-19 experiences from the perspective of vulnerable and/or marginalised people raising greater awareness for issues of health equity. The WHO defines health equity as the influence that non-medical factors have on health outcomes. For example, this can include income, education levels, job insecurity, food, housing, social inclusion, access to affordable health services, as well as policy systems (https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1). Fostering empathy and care for others’ wellbeing is a key component of effective public health campaigns. Comics can be a powerful medium for evoking emotions and empathy, which in turn can support prosocial behavioural change by shifting perspectives and attitudes (Pfattheicher et al., 2022).

As our sample showed, this can be done either by creating relatable characters in comics centred on conveying information (infocomics), or by telling character-driven stories that prompt the reader to reflect on how individual experiences might be systematic or play out on a broader, social level (e.g., slice of life, testimonial, political comics). For example, in Fig. 8.2, originally posted by _coronadiary, the #unheardcovid series showed experiences of people who have been ‘left out the conversation’ during COVID-19. In this special collaborative series #unheardcovid, Jackson used composite characters to represent people that are often left out of public narratives around COVID-19. For this project she partnered with @risingartsagency. Together, they responded to the question: Who is left out of the conversation? “I asked followers for feedback and there was a lot!” Jackson explains on her Instagram account, “I picked 9 answers then spoke either directly to people who identified under these categories or alternatively found online quotes from those in response to the pandemic” (https://www.instagram.com/p/CG2rDpsFQNY/). The series includes a teacher, a pregnant person, a child, a homeless person, a medic, a disabled person, an evicted migrant, someone with long COVID, and someone shielding.

Fig. 8.2

Panels from Monique Jacskon’s #unheardcovid series, follow Monique’s work on Instagram @_coronadiary (https://www.instagram.com/p/CHK1piYl6qj/)

Jackson’s illustrations bring these demographic categories to live through the creation of relatable characters. This practice can help foster empathy for those different from ourselves. This visually engaging, humanising approach to communicating marginalised experiences invites the audience to consider the pandemic from a perspective different to their own, and relatable character illustration humanising the impersonal, numerical data often presented in the news. Comments left on the series’ posts displayed support and empathy for those in each situation. “Financial support for all of the people in this position is so crucial! Horrible to think of people forcing themselves back to work too early.” and “Love your [sic] looking after those who are neglected thanks for your important work!”

Further analysis and audience reception research should be done to investigate visual metaphor as a tool for rapidly communicating complex public health information to non-specialist audiences.

4.2 Data Literacy

The increasing popularity of comics and data comics can be leveraged to amplify the circulation of authentic health information in ways that help build not only health literacy, but also data and information literacy. Creating a culture of good evidence-based communication practices among comics artists can help counter misinformation online and improve information literacy. As in mainstream reporting, crediting sources of comic data for health information and data in comics to expert sources like the CDC and the WHO have been found to be effective at correcting health misinformation on social media (Vraga & Bode, 2017). Moreover, by repeatedly referencing authorial sources in their public health messaging, and developing a reputation for offering verified information, comic artists can become science communication influencers whose messages can trigger adoption through positive social reinforcement (Zhou et al., 2015).

In our dataset of comics, sources were referenced in only 10% of comics, with only half these references citing authorial sources. Good referencing and authorial source citation practices were most common in infocomics. Promisingly, of the top 10 users with the most liked infocomics, the top 3 all engaged with authorial source referencing practices.

Failure to reference does not rest with the artists alone. Instagram has several platform constraints that makes it challenging for users to establish credibility for their posts. For example, Instagram has a ‘no-clickable-link’ policy in posts. The platform only allows for one link that users must put in their profile bios, making it challenging for this to function to be used as a post reference. While these policies are useful for preventing spam and countering online scams, it makes it challenging for artists to include links to authorial and evidence-based sources in their comics.

In response to this platform constraint, some artists put URLs in their images or captions to lead followers to health authorities as a way of establishing authentication and countering misinformation with their comics. Such effort is frustrated by the fact that the URLs do not appear as hyperlinks when posted, and often cannot be copied and pasted from Instagram’s mobile app, making it difficult to follow the link to its source. Whilst not ideal, sharing references visually and noting authorial sources through @ mentions are important for establishing chains of accountability and generating trust with both readers and public health professionals.

Our data highlights the need for further research into referencing practices as a potential force for countering misinformation on visually based social media. It also calls for more training and resources to be put into supporting communities of practice around evidence-based artistic practice. At the same time, our findings suggest that it should be the responsibility of social media platforms to enable and foster evidence-based communication online. Better practice in source verification can be embedded into platform design. For example, users could be prompted about referencing and fact-checking practices in the same way that platforms now inform users about third party data and personalised advertising through interface pop-ups or ‘more information’ buttons.

In her comic on how COVID-19 spreads, artist @weimankow (see Fig. 8.3) embeds references to the CDC and WHO in this comic panel and credits a medical expert who vetted the health message in the comic by using an @ mention in the caption box. Another comic in our sample by Monique Jackson (@_coronadiary) (see Fig. 8.4), draws attention to the lethal impact of COVID-19 to counter the myth that it is just another seasonal flu. Providing an evidence-base for her comic, Jackson visually references a scientific paper from The Lancet which compares data from COVID-19 and the seasonal flu.

Fig. 8.3

Comic by Weiman Kow. Follow Weiman’s work on Instagram @weimankow (https://www.instagram.com/p/B_aN_VxHP8j/)

Fig. 8.4

Art by Monique Jackson. Follow Monique’s work on Instagram @_coronadiary (https://www.instagram.com/p/CJ6xVi8l1sN/)

One of the most challenging issues for science communication is how to handle uncertainty. As data and charts became part of our daily lives, people were repeatedly asked to see themselves against the pandemic’s health statistics, graphs, charts, and changing projections. We were called upon to continuously evaluate and re-evaluate numbers and figures, while also constantly being told that the figures were estimates, the data was incomplete, the projections were contested, and correct case and death counts were unknown.

This data uncertainty was deeply entangled with the larger uncertainties of pandemic life. In addition to the mental health and wellness impacts of the social and economic factors of the pandemic, this uncertainty itself has led to increased mental distress (Bryce et al., 2020; Koffman et al., 2020; Rutter et al., 2020). ‘Stuck in fight or flight mode’, the cognitive psychology language of trauma has entered popular vocabulary as people struggle to navigate life amid so much uncertainty. It has become clear through the pandemic that we have a lack of language and resources for handling so much of it.

In our sample of comics, only 3% addressed issues of uncertainty, yet 3 of the top 5 most commented on artists addressed uncertainty in their work. In addition, the most prolific artist in our sample, @drmaypole, expressed uncertainty in 30% of his comics, which were often drawn from his experiences interacting with patients, and children, as a doctor during the pandemic. Comics addressing uncertainty were most prevalent in the infocomics genre where scientific uncertainty around safety protocols, testing, and vaccination was contextualised and explained, as well as in ‘slice of life’ comics where uncertainty was expressed in relation to mental health. Humour was also used to navigate uncertainty, acknowledging both shared states of anxiety and shared frustrations in governmental guidance.

For example, in September 2020, cartoonist and hospital administrator Katy Doughty (see Fig. 8.5) created a web-comic called ‘We Might Not Ever Know the True Toll of COVID-19’ (https://thenib.com/the-true-toll-of-covid-19/). As part of her hospital job, Doughty was responsible for updating her hospital’s online COVID-19 guide. Her web-comic illustrates her reflections on the messiness of COVID-19 data and its collection. In one stark panel the bars of a bar graph tumble and fall over each other like the planks of a broken fence. Some of them fall into a blood red mound at the bottom of the graph, paired with the caption “The truth is COVID-19 statistics are a mess.” Doughty’s sombre text relates the struggle of keeping up to date with the death count.

Fig. 8.5

Panel excerpts from Katy Doughty’s comic We Might Not Ever Know the True Toll of COVID-19 published on The Nib. Follow Katy’s comics on Instagram @katydoughtydraws (https://www.instagram.com/p/CFaUaxBjhnG/?utm_source=ig_web_copy_link)

Two panels show neat rows of hospital beds. The first filled with blank outlines of bodies reads: “Most case statistics in the U.S. don’t include information about race and the CDC had to be sued before releasing the data that they do have.” The following panel shows the same scene, this time the beds are filled with black and brown bodies. Here the paired caption text narrates, “The data is sparse, but damning. Latinx and Black people are three times as likely to get COVID-19 as white people, and twice as likely to die from it.”

Doughty’s sequential artwork on the statistical chaos of COVID-19 uses a stripped back colour scheme, resonant iconography, and layers of text to convey the contrast between what we see on the ‘data surface’ versus the realities behind the scenes. Doughty’s comic legitimates the human experience of chaos, while making visible data that is absent, uncounted, or hidden. Most importantly, it does this in a way that spotlights—rather than shies away from—the systematic failures and vulnerabilities revealed by all that what we cannot yet count.

Sometimes the best thing that can be done in times of uncertainty is acknowledge it. Recent research by Van Der Bles et al. (2020) found that “a key challenge to maintaining public trust in science is for communicators to be honest and transparent about the limitations of our current state of knowledge.” Our findings suggest that comics can serve as a medium to help health professionals and scientists communicate uncertainty in ways that are engaging and accessible to social media audiences. Further research is needed into effective strategies for communicating scientific uncertainty and utilising social media as a forum to build resilience in uncertain times. Returning to the concept of the third space, our findings suggest that these dynamic practices of engaging with data and its shortcomings can enhance media literacies, particularly in relation to not only consuming, but creating, sharing and interacting on social media.

4.3 Media Literacy

In the context of an ‘information disorder’ (Wardle & Derakhshan, 2017) media literacy research, practice and activism increasingly resists binaries between authoritative and ‘fake’. More critical, capacity-building and dynamic media literacy work tends to facilitate healthy cynicism about and resilience to all media in combination with the capacity to act through the collective, civic uses of such literacy practices (Hoggart, 1957, Bennett, McDougall and Potter, 2020). The ‘state of the art’ of the media literacy field presents this shift from competence frameworks to a negotiation of dynamic, experiential, and reflexive media literacy practices. This shift responds to the urgent need to understand how literacies are impacted by and, in turn, impact on social media, data and algorithms.

The UNESCO declaration on media literacy is over-arching and includes all aspects of digital media literacy (DML). The declaration is regularly updated to take account of global issues and the most recent update situates media literacy as a ‘defence against disinfodemics’ (UNESCO, 2020). This foregrounds media literacy as a first response to information disorder - the combined effects of online misinformation; mainstream media disseminating ‘poor quality information’ through the web; weakened local media reducing diversity, the narrowing scope of media representation undermining democracy; the use of data for demographic targeting and the deployment of ‘bots’ for large-scale viral circulation of misinformation.

Austin et al. (2021) applied an established media literacy assessment model (NAMLE, 2007) to test the hypothesis that, as media literacy enables agency in information environments, media literate citizens would be better placed to interpret emerging health information in a time of crisis and develop self-protective behaviours, finding that “Individuals with more media literacy are better prepared and willing to take experts’ recommended preventive actions.” (Austin et al., 2021: 11). This intersection of media literacy, COVID-19 and citizen action locates media literacy during and after the pandemic as being more about citizens interacting differently with media ecosystems. This is an active shift in thinking about the agentive uses of media literacy. Rather than assuming that media literacy competences can be measured as ‘more or less developed’ and then, once develpoed, assumed to lead to both communicative resilience and capacity to make positive change in themselves, this way of thinking separates competences from capability. Our theory of change for media literacy then goes further still to link capability to the consequences of actions – behaviour change in the ecosystem – and to look for positive uses of media literacy for social justice, beyond both competence and resilience.

Research into how media literacy relates to the capacity to interpret health (mis)information during the COVID-19 crisis, including this study, investigates the visual representation of COVID-19 information across social media platforms and various forms of response to the cultural politics of data. Musi and Carmi (2020) contribute a ‘crisis informatics’ approach to global digital activism in times of COVID-19. The methods ‘reverse-engineer’ COVID-19 misinformation, a form of ‘mining back’ data. This new and emerging sub-field of media literacy research focuses on the power that citizens have to respond to misinformation. Our research shares this ethos. We argue that critical engagement with social media content creation – from understanding platform optimization to the operation of their algorithms – can contribute to our methodological and conceptual approaches to literacy as dynamic and interdependent on (social) media ecosystems.

Digital optimisation refers to the practice of improving content production processes to increase digital visibility and engagement. Understanding how digital optimisation works on different platforms is now crucial for developing media literacy and becoming a reflexive content creator. All social media platforms have limitations on how content can be posted and shared. Learning how to navigate these parameters is essential for maximising the efficacy of public health messages on social media. In relation to optimising comics and related visual material for Instagram, there are two major areas that need attention - how to overcome aesthetic limitations, and how to overcome algorithmic limitations.

Optimisation on Instagram involves considering how art will translate into Instagram’s square single-image and 10-image slider formats. Abiding by the Instagram square is useful for content creators as it ensures that the image fits within the mobile app layout. Users often access Instagram on mobile phones, which means they view the content through smaller screens which can result in decreased readability if the comic does not fit within the optimum aspect ratio.

Instagram allows for a 4:5 aspect ratio for portrait images and 1.91:1 for landscape. However, the optimum size for the platform is 1:1, commonly called the Instagram square. Any image that is larger than these aspect ratios automatically gets cropped in order to be uploaded onto the app. Instagram also offers a slider function that allows for up to 10 images to be uploaded in a single post. In posts that use this function for multiple images, users are still limited to a fixed aspect ratio, where the aspect ratio used in the first image needs to be maintained across all images in the same post. Here, again, the ‘Instagram square’ format is best suited to the platform.

Whilst still limited, the slider function on Instagram allows a maximum of 10 images in each post, providing opportunities for artists who wish to share content that does not fit within a single square image. The standard practice used by most Instagram-based comic artists is to post either a single image with no more than four comic panels, or to present each comic panel as a single square and use the slider function as a way for readers to follow the narrative progression. In comics that use the slider function, the swipe becomes akin to the gutter in a traditional comic panel layout.

In our dataset, the majority of artists opted for square format and single image posts. We found that 53% of posts were a single image, with 67% of posts using a square panel format. The second most common format was a four-panel comic that either opted for 4 squares within a square layout or a slider of 4 individual panels. Ranked by engagement data, the 10 most-liked and commented-on artists opted for square panel layouts over 90% of the time, with just under 50 of their posts being single images. The number of panels used varied from 1 up to 19. Among the top 50 most liked and commented on posts, over 75% of posts included square panels, with 42% being single image posts. Again, the number of panels varied, here from 1 to 22.

Insights from this data show that the Instagram square is key to visual optimisation and engagement with public health comics, as is scaling text and visual iconography in way that it remains legible for reading on mobile devices. Yet, while the scarcity of attention online and the need to grab audiences quickly should be considered, in our findings, reader engagement was not limited to single image, single-panel posts.

This suggests that various approaches to sequential storytelling can drive engagement, meaning creators have room to give some depth to characters, explain more complex data or breakdown information over the course of multiple panels and images. It also suggests that when comics can create an immersive, connective reader experience, it may be able to stand out in an over-saturated, visual information environment (Wolf, 2014). Further research into audience engagement, attention span, and the potential of visual, sequential storytelling on social media is needed.

The strategic use of hashtags are also a part of developing social media literacy. Hashtags can increase social media attention to public health messages. Hashtags on social media platforms are used to make content searchable (Zappavigna, 2011). By segmenting content into specific topics, hashtags enable people who are interested in a subject to come together. As a content creator, they are one of the best tools to help ensure posts reach your target audience. For example, in the COVID-19 comics we analysed, we saw this in the use of hashtags such as “#quarantinelife” where the posts containing the hashtag aims to share relatable experiences for those who are in quarantine at the same time.

However, the use of hashtags varies heavily amongst Instagram users (McCosker & Gerrard, 2020). For instance, hashtags are often added to an image that further describes or amplifies its message but does not necessarily aim to open a space of discussion or reach specific target audiences (Highfield & Leaver, 2015). This can be seen in our sample through the use of trending COVID-19 hashtag lists, such as #wearamask, #staysafe, and #stayathome. While these public health directives may work to reinforce official messaging, they often only reach users who already share a similar point of view.

Recent research increasingly provides evidence that users can encounter opposing viewpoints in online spaces despite algorithmic curation and personalisation which was previously believed to trap users into homogenous filter bubbles (Messing & Westwood, 2014; Dubois & Blank, 2018). This suggests that online spaces do indeed create opportunities to reach those who are sceptical or unaware of public health messaging. For instance, research shows that during the pandemic over 60% of Instagram users surveyed were using the generic hashtag #coronavirus to share information about the pandemic (Rovetta & Bhagavathula, 2020). This is in line with what we observed in our dataset.

Drawing insight from this data, we would suggest that in order to further instigate behavioural change and raise awareness on Instagram, directive hashtags such as #wearamask should be used in combination with trending, generic hashtags that are more likely to circulate in communities beyond one’s existing belief system. In addition, Rovetta and Bhagavathula (2020) point out that generic hashtags are frequently used by those spreading misinformation. This suggests that using such hashtags may help reach audiences that are more sceptical about public health information. Further research should be done to see how hashtag use in evidence-based visual media like comics can provide opportunities to interrupt and disrupt flows of misinformation on social media.

Another practice that can be used by social media content creators to widen audiences is using location-specific or audience-specific hashtags. Several posts in our dataset utilised hashtags such as, #coviditaly, #coronavirusgermany, #covidmalaysia to signal the relevance of the message by country. For example, James Fulmer MD (see Fig. 8.6), uses both various hashtags relevant to certain countries, as well as hashtags such as #emergencynurse, #criticalcarenurse and #icunurse to signal specific occupational audiences that may find this content relevant. He also uses #graphicmedicine, linking his work into an existing community of health-based comics creators, scholars, and fans. Fulmer hashtasgs the post #facemasks rather than the directive #wearamask, as well as using a string of COVID-19 generic hashtags like #covid, #covid19, and #coronamemes, providing a good example of how to use a more generic hashtag list in efforts to reach a wider demographic. General social media advice for using hashtags on Instagram varies from 3–5 to up to 30.

Fig. 8.6

comic by James Fulmer MD. Follow James’ comics on Instagram @doctorwarsgame (https://www.instagram.com/p/B97j-f7hjyg/)

In addition to hashtags, another key element of building (social) media literacy is developing skills in working with social media platforms’ interactive functions in ways that promote evidence-based communication and empathy. Interactivity on social media refers to messages that prompt the audience to share their experience or perspective in response to a post. In our sample, these kinds of interactivity prompts appeared either within a comic panel or in the post caption box. While interactivity was only used in 15% of the comics in our sample, 11 of the top 25 users with the most comments used interactivity in their comics, their captions, or both.

Analysing the comments on posts that included interactivity shows the potential that interactive social media engagement can have for building deeper understandings of public health issues. While the negative impacts of online comments are well documented, we found, in line with recent research, that the comments sections of public health comics can become deliberative spaces where people share experiences and discover new information or resources (Andalibi et al., 2017).

In our sample, the comments sections of comics that included elements of health literacy, provided opportunities for readers to share opinions and ask questions. This can help increase comprehension through personal engagement and make health and scientific information more relatable, which contributes to information comprehension and retention (Martin & MacDonald, 2020). Comments are also useful spaces for artists to add further nuance to information shared in the comic and address reader questions.

By addressing people’s scepticism, dialogue in the comments section of comic posts can offer a place to examine and accept scientific uncertainty. In efforts to counter scaremongering in the comments, in one post artist Maaike Hartjes pointed her readers to preliminary scientific results. In the comments section of two of Hartjes’ other posts featuring vaccination comics, several people declared that the comic led them to better understand how the vaccines worked and one person claimed that this artist’s comics convinced them to take the vaccine. In another set of comics about restrictions, people from many different countries used the comments to discuss and make sense of their own country’s way of dealing with the pandemic.

Artists’ dialogues with readers show us that when artists are willing to engage with fact-checking and respond to queries, they can build health literacy together. While artists are of course not authorial sources themselves, these nascent findings point to the potential impact that collaborations between artists and health organisations could have. Combining the accessibility and relatability of comics with the interactivity afforded by social media could prove a fruitive ground for challenging mis/disinformation. Further, this combination of accessibility, relatability and interactivity works to support the four elements of media literacy (see BBC Media Actiion, 2022). These are access (to health information); awareness (of how public health is represented and the need for diversity); capability (to reflect on the impact of covid on the inner world) and consequences (more mindful engagement with data and sharing behaviours). Approaching media literacy through this case study of comics lets us see how people can transform their existing literacies into the capability to make informed decisions about public health. This focus on media literacy developing into broader social and civic capability is informed by the work of Sen (2008).

Finally, digital optimisation can also mean knowing how to navigate restrictions that are put in place by platform algorithms. How much visibility a post gets can be determined through engagement (i.e., the more comments and likes the content has, the more it is amplified), or through hashtags and mentions that notify the algorithms about who might be interested in seeing a particular content. Algorithms are also used to find content and accounts that breach terms of service or copyright laws. Platforms may additionally choose to suppress certain content that they deem harmful by reducing its visibility and reach. This can include banning hashtags or accounts, which has become a popular method of fighting the proliferation of fake news and misinformation in recent years.

However, algorithmic interventions that aim to suppress mis/dis-information can sometimes result in the suppression of evidence-based informational posts on the same topics. In late 2020, in an attempt to curb misinformation, Instagram changed its rules around COVID-19-related content in order to suppress posts that were not shared by an authorial health institution. Users were directed to the WHO’s Instagram account when they searched for hashtags about COVID-19 and posts that contained COVID-19 related information were marked with a banner that alerted the viewer to a local public health authorities’ website based on their location.

In relation to our study, these attempts to curb misinformation meant that comic artists who were aiming to increase health literacy by explaining complex medical information were also being targeted by Instagram’s algorithm. This resulted in the suppression of their posts. The content was sometimes flagged, left out of post feeds, and reached fewer users as a result. In response to this algorithmic limitation, some artists started to mobilise their followers on Instagram, employing grassroots attempts to ‘trick’ the algorithm by urging their followers and viewers to like, comment, and save posts to amplify their reach. For example, in a post explaining the differences between COVID-19 variants and mutations, artist Maaike Hartjes explains how readers can help make artists’ work on COVID-19 more visible. Here, Hartjes helps foster a community of practice around supporting artists on social media at the same time as she tries to build literacy, not only on COVID-19, but also on the ways that a platform algorithm works (Fig. 8.7).

Fig. 8.7

Comic by Maaike Hartjes (https://www.instagram.com/p/CKv60QPlSmF/)

5 Conclusion and Policy Recommendations

Regarding the contribution this study makes to the field of media literacy, we know that media literate people are more able to make informed decisions about issues that affect their lives and have greater resilience to information disorder. By applying a theory of change for media literacy, linking access to awareness to capability and consequences to the efficacy of web-comics for ‘third space’ public health, we have found that:

• Public health web-comics address information ecosystem challenges by making a positive contribution to the diversity of the system and increasing trustworthy content;

• Public health web-comics have the potential to convert media literacy into a broader capability through inner world reflexivity; representations of mental health and media texts interacting with audiences’ ‘living covid literacies’ in real time;

• Public health web-comics can combine this capability development with positive consequences and behaviour change, through more mindful engagement with data and a reduction in sharing information without thinking.

Based on the findings arising from our research, we put forward the following recommendations.

• 1. Best practice in public health messaging should combine visual storytelling and referencing techniques through dynamic ‘third space’ approaches that acknowledge the existing literacy practices of their audiences.

• 2. Communities of practice should be further developed to investigate and enhance creative, evidence-based communications on social media. This includes bringing visual metaphor, resonant icons, gesture, experiential scales, and internal emotional worlds into the visual communication of scientific and statistical reporting, as well as training in data referencing and social media optimisation skills.

• 3. Public Health bodies should work with comics artists on the creation and distribution of public health messaging campaigns. These collaborations are often most successful when artists can tap into their existing reader networks and retain ownership over their creative work.

• 4. Social Media platform regulation should focus not only on supressing and flagging dis/misinformation, but also on helping to tag and amplify evidence-based posts. For example, a “green tick”, similar to the “blue tick” used for verified public figures, could be used to verify the credibility of science communicators.

• 5. Platform regulation should be combined with strategies to strengthen people’s resilience to health misinformation through media literacy, taking the transferable principles from how comics combine accessibility, relatability and interactivity to support the conversion of existing literacies into information capabilities.

• 6. More work at policy level needs to be done to achieve free access to social media data. Corporations like Facebook (now Meta) have failed to preserve visual archives. They do not make data easily searchable or accessible to researchers, limiting our ability to study social phenomena and preserve digital cultural heritage.