A qualitative evaluation of storytelling narratives designed as strategy to increase uptake of lung cancer screening for veterans

INTRODUCTION: Lung cancer screening with low-dose computed tomography (LDCT) reduces lung cancer mortality. However, LDCT utilization remains low, including in the Veterans Health Administration. Personal storytelling narratives are an evidence-based strategy to influence healthy behaviors like lung cancer screening. However, little is known about how Veterans might respond to narratives. We aimed to develop 3 preliminary digital (video) narratives about lung cancer screening and elicit feedback from Veterans about the narratives. METHODS: In partnership with StoryCenter, we worked with three Veterans (i.e., Storytellers) to develop preliminary personal digital storytelling narratives about their lung cancer screening experiences. To elicit feedback, we recruited Veterans (i.e. interviewees) at a single Veterans Affairs Medical Center between January 14, 2025, and June 13, 2025 to view the narratives and participate in an interview. Guided by the Learner Verification and Revision technique, we conducted semi-structured interviews. We analyzed and organized qualitative data by constructs of the Learner Verification and Revision technique including: i) visual and auditory appeal of the tool (Attraction); ii) whether the tool is socially agreeable (Acceptability); iii) how well the viewer understood the central message of the tool (Comprehension) and whether the message compels the viewer to complete the suggested action (Persuasion); and iv) how confident the viewer is they are able to complete the suggested action (Self-efficacy). RESULTS: Interviewees (n=30) generally perceived the videos as having compelling visual and auditory elements, noting the importance of subtitles and high-quality images (Attraction). Interviewees found few aspects of the narratives unacceptable, although casual language and discussion topics were noted as potentially off-putting (Acceptability). Narratives that displayed the CT scanner and portrayed Storytellers' screening experiences were most informative, reduced anxiety and built trust. Interviewees connected with narratives that reflected shared experiences such as smoking history, military service, and family responsibilities, viewing these as motivational to pursue screening. Nevertheless, some aspects of the narratives were less well-liked due to personal histories and experiences (Comprehension/Persuasion). Several interviewees stated the videos motivated them for screening, but noted the videos did not adequately describe next steps (Self-efficacy). Interviewees suggested future narratives emphasize the ease and benefits of screening, while integrating relatable and motivating messages. CONCLUSIONS: Leveraging Veteran feedback to modify preliminary personal digital storytelling narratives can inform and improve future iterations of narratives for broader implementation.