Health Preparedness and Narrative Rationality: A Call for Narrative Preparedness

Document Type : Original Article


Centre for Sustainable Healthcare Education, Faculty of Medicine, University of Oslo, Oslo, Norway


This conceptual paper argues the need for narrative preparedness, understood as the ability to engage and empathize with peoples’ stories and the values they encode, assess them based on the universe in which people live, and acknowledge the narrative rationality of each story – even when it conflicts with the rationality of science. Expanding ‘health preparedness’ to encompass ‘narrative preparedness’ complements the ideals of patient centeredness, which are sometimes betrayed when implemented into concrete decisions because the rationality of science that underpins medical practice fails to make sense of patients’ stories. We outline the central tenets of narrative preparedness and demonstrate its relevance by discussing various responses to mainstream discourses on COVID-19 as a case in point. We discuss and further develop Fisher’s narrative paradigm, which provides a model that complements traditional, scientific rationality with attention to narrative rationality and a radical democratic ground for health political critique. Applying the narrative paradigm to authentic examples of vaccine hesitancy and anti-vaccination demonstrates how closer attention to the way narratives are assessed by different constituencies might help us mitigate some of the sources of resistance and misunderstanding that continue to plague public communication about important medical issues such as pandemics. Health authorities must acknowledge and engage with the stories people believe in and their reasons for doing so. The crucial question for the success of health policy interventions is not only ‘what are the facts’ but ‘how do these facts make sense to people, and why.’ To be prepared for the next pandemic, health professionals must learn to engage with people’s stories and the processes by which they come to be understood and assessed differently by various constituencies.


Main Subjects

  1. Bollyky TJ, Hulland EN, Barber RM, et al. Pandemic preparedness and COVID-19: an exploratory analysis of infection and fatality rates, and contextual factors associated with preparedness in 177 countries, from Jan 1, 2020, to Sept 30, 2021. Lancet. 2022;399(10334):1489-1512. doi:1016/s0140-6736(22)00172-6
  2. Haldane V, Jung AS, Neill R, et al. From response to transformation: how countries can strengthen national pandemic preparedness and response systems. BMJ. 2021;375:e067507. doi:1136/bmj-2021-067507
  3. Lazarus JV, Ratzan SC, Palayew A, et al. A global survey of potential acceptance of a COVID-19 vaccine. Nat Med. 2021;27(2):225-228. doi:1038/s41591-020-1124-9
  4. Chabal E. The real reason France is skeptical of vaccines. Foreign Policy. February 3, 2021.
  5. Davidson B. Storytelling and evidence-based policy: lessons from the grey literature. Palgrave Commun. 2017;3(1):17093. doi:1057/palcomms.2017.93
  6. Oschatz C, Marker C. Long-term persuasive effects in narrative communication research: a meta-analysis. J Commun. 2020;70(4):473-496. doi:1093/joc/jqaa017
  7. Ratcliff CL, Sun Y. Overcoming resistance through narratives: findings from a meta-analytic review. Hum Commun Res. 2020;46(4):412-443. doi:1093/hcr/hqz017
  8. Ballard AM, Davis A, Hoffner CA. The impact of health narratives on persuasion in African American women: a systematic review and meta-analysis. Health Commun. 2021;36(5):560-571. doi:1080/10410236.2020.1731936
  9. Dillon S, Craig C. Storylistening: Narrative Evidence and Public Reasoning. Routledge; 2022.
  10. Kottow M, Kottow A. Literary narrative in medical practice. Med Humanit. 2002;28(1):41-44. doi:1136/mh.28.1.41
  11. Williams IC. Graphic medicine: comics as medical narrative. Med Humanit. 2012;38(1):21-27. doi:1136/medhum-2011-010093
  12. Howell J. COVID-19 narratives and layered temporality. Med Humanit. 2022;48(2):211-220. doi:1136/medhum-2021-012258
  13. Solomon M. Making Medical Knowledge. Oxford University Press; 2015.
  14. Charon R, DasGupta S, Hermann N, et al. The Principles and Practice of Narrative Medicine. Oxford University Press; 2016.
  15. Baker M. Translation and Conflict: A Narrative Account. Routledge; 2018.
  16. White H. The value of narrativity in the representation of reality. Crit Inq. 1980;7(1):5-27. doi:1086/448086
  17. Currie M. Postmodern Narrative Theory. Palgrave Macmillan; 2011.
  18. White H. The Content of the Form: Narrative Discourse and Historical Representation. John Hopkins University Press; 1987.
  19. Somers M. Deconstructing and reconstructing class formation theory: narrativity, relational analysis, and social theory. In: Hall JR, ed. Reworking Class. Cornell University Press; 1987.
  20. Sample I. Vaccine Hesitancy in Some Health Workers in England 'May Undermine Rollout.’ The Guardian. February 14, 2021.
  21. Fisher WR. Narrative rationality and the logic of scientific discourse. Argumentation. 1994;8(1):21-32. doi:1007/bf00710701
  22. Fisher WR. Human Communication as Narration: Toward a Philosophy of Reason, Value, and Action. University of South Carolina Press; 1987.
  23. Engebretsen E, Baker M. Rethinking Evidence in the Time of Pandemics. Cambridge: Cambridge University Press; 2022.
  24. Landau M. Human evolution as narrative. In: Hinchman LP, Hinchman S, eds. Memory, Identity, Community: The Idea of Narrative in the Human Sciences. Suny Press; 1997:104-118.
  25. Larson HJ. Stuck: How Vaccine Rumors Start--and Why They Don't Go Away. Oxford University Press; 2020.
  26. Pertwee E, Simas C, Larson HJ. An epidemic of uncertainty: rumors, conspiracy theories and vaccine hesitancy. Nat Med. 2022;28(3):456-459. doi:1038/s41591-022-01728-z
  27. Farhart CE, Douglas-Durham E, Lunz Trujillo K, Vitriol JA. Vax attacks: how conspiracy theory belief undermines vaccine support. Prog Mol Biol Transl Sci. 2022;188(1):135-169. doi:1016/bs.pmbts.2021.11.001
  28. Gruber K. Preventing zoonotic pandemics: are we there yet? Lancet Microbe. 2021;2(8):e352. doi:1016/s2666-5247(21)00187-7
  29. Ottersen OP, Engebretsen E. COVID-19 puts the sustainable development goals center stage. Nat Med. 2020;26(11):1672-1673. doi:1038/s41591-020-1094-y
  30. El Zowalaty ME, Järhult JD. From SARS to COVID-19: a previously unknown SARS- related coronavirus (SARS-CoV-2) of pandemic potential infecting humans - call for a One Health approach. One Health. 2020;9:100124. doi:1016/j.onehlt.2020.100124
  31. Sirleaf EJ, Clark H. Report of the Independent Panel for Pandemic Preparedness and Response: making COVID-19 the last pandemic. Lancet. 2021;398(10295):101-103. doi:1016/s0140-6736(21)01095-3
  32. Tomson G, Causevic S, Ottersen OP, et al. Solidarity and universal preparedness for health after COVID-19. BMJ. 2021;372:n59. doi:1136/bmj.n59
  33. Heggen K, Sandset TJ, Engebretsen E. COVID-19 and sustainable development goals. Bull World Health Organ. 2020;98(10):646. doi:2471/blt.20.263533
  34. Rocha R, Atun R, Massuda A, et al. Effect of socioeconomic inequalities and vulnerabilities on health-system preparedness and response to COVID-19 in Brazil: a comprehensive analysis. Lancet Glob Health. 2021;9(6):e782-e792. doi:1016/s2214-109x(21)00081-4
  35. Nan X, Iles IA, Yang B, Ma Z. Public health messaging during the COVID-19 pandemic and beyond: lessons from communication science. Health Commun. 2022;37(1):1-19. doi:1080/10410236.2021.1994910
  36. Jose R, Narendran M, Bindu A, Beevi N, L M, Benny PV. Public perception and preparedness for the pandemic COVID 19: a health belief model approach. Clin Epidemiol Glob Health. 2021;9:41-46. doi:1016/j.cegh.2020.06.009
  37. Paakkari L, Okan O. COVID-19: health literacy is an underestimated problem. Lancet Public Health. 2020;5(5):e249-e250. doi:1016/s2468-2667(20)30086-4
  38. Kandel N, Chungong S. Dynamic preparedness metric: a paradigm shift to measure and act on preparedness. Lancet Glob Health. 2022;10(5):e615-e616. doi:1016/s2214-109x(22)00097-3
  39. Guttman N, Lev E. Ethical issues in COVID-19 communication to mitigate the pandemic: dilemmas and practical implications. Health Commun. 2021;36(1):116-123. doi:1080/10410236.2020.1847439
  40. MacKay M, Colangeli T, Thaivalappil A, Del Bianco A, McWhirter J, Papadopoulos A. A review and analysis of the literature on public health emergency communication practices. J Community Health. 2022;47(1):150-162. doi:1007/s10900-021-01032-w
  41. Islam MS, Sarkar T, Khan SH, et al. COVID-19-related infodemic and its impact on public health: a global social media analysis. Am J Trop Med Hyg. 2020;103(4):1621-1629. doi:4269/ajtmh.20-0812
  42. Dillard JP, Shen L. The Sage Handbook of Persuasion. SAGE Publications; 2013.
  43. O’Keefe DJ. Persuasion: Theory and Research. 3rd ed. SAGE Publications; 2015.
  44. Cho H. Health Communication Message Design: Theory and Practice. SAGE Publications; 2011.
  45. Harrington NG. Persuasive health message design. In: Nussbaum J, ed. Oxford Research Encyclopedia of Communication. New York: Oxford University Press; 2016.
  46. Green MC, Brock TC. The role of transportation in the persuasiveness of public narratives. J Pers Soc Psychol. 2000;79(5):701-721. doi:1037//0022-3514.79.5.701
  47. Slater MD, Rouner D. Entertainment—education and elaboration likelihood: understanding the processing of narrative persuasion. Commun Theory. 2002;12(2):173-191. doi:1111/j.1468-2885.2002.tb00265.x
  48. Greenhalgh T. Cultural Contexts of Health: The Use of Narrative Research in the Health Sector. WHO Regional Office for Europe; 2016.
  49. Greenhalgh T. Of lamp posts, keys, and fabled drunkards: a perspectival tale of 4 guidelines. J Eval Clin Pract. 2018;24(5):1132-1138. doi:1111/jep.12925
  50. NACI chair on vaccine advice. YouTube website.
  51. European Medicines Agency. COVID-19 Vaccine AstraZeneca: PRAC Investigating Cases of Thromboembolic Events - Vaccine’s Benefits Currently Still Outweigh Risks, 11 March 2021.
  52. European Medicines Agency. AstraZeneca’s COVID-19 Vaccine: EMA Finds Possible Link to Very Rare Cases of Unusual Blood Clots with Low Blood Platelets. Published April 7, 2021.
  53. European Medicines Agency. VAXZEVRIA/COVID-19 Vaccine AstraZeneca: Link Between the Vaccine and the Occurrence of Thrombosis in Combination with Thrombocytopenia. April 7, 2021.
  54. European Medicines Agency. VAXZEVRIA/COVID-19 Vaccine AstraZeneca: Risk of Thrombosis in Combination with Thrombocytopenia – Updated Information. May 20, 2021.
  55. Kahn JP, Henry LM, Mastroianni AC, Chen WH, Macklin R. Opinion: for now, it's unethical to use human challenge studies for SARS-CoV-2 vaccine development. Proc Natl Acad Sci U S A. 2020;117(46):28538-28542. doi:1073/pnas.2021189117
  56. Jiang S. Don't rush to deploy COVID-19 vaccines and drugs without sufficient safety guarantees. Nature. 2020;579(7799):321. doi:1038/d41586-020-00751-9
  57. Christiansen AT, Andersen MM, Kappel K. Are current EU policies on GMOs justified? Transgenic Res. 2019;28(2):267-286. doi:1007/s11248-019-00120-x
  59. Anslow L. Lefties Planted the Anti-Science Seed Fueling Vaccine Skepticism. The Daily Beast. August 23, 2021.
  60. Brookes G. COVID-19 Vaccines & Genetic Modification. Open Access Government. June 3, 2021.
  61. Dyer C. COVID-19: irish GP who refused to vaccinate patients is suspended. BMJ. 2021;373:n987. doi:1136/bmj.n987
  62. Cullen P. GP Suspended by Medical Council over Refusal to Give COVID-19 Vaccine. The Irish Times. March 22, 2021.
  63. O’Connor R. 'Conscientious Objector' Irish GP Suspended by Medical Council for Refusing to Vaccinate Patients. The Irish Post. March 22, 2021.
  64. Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between Blacks and Whites. Proc Natl Acad Sci U S A. 2016;113(16):4296-4301. doi:1073/pnas.1516047113
  65. Yearby R, Clark B, Figueroa JF. Structural racism in historical and modern US health care policy. Health Aff (Millwood). 2022;41(2):187-194. doi:1377/hlthaff.2021.01466
  66. Forman R, Shah S, Jeurissen P, Jit M, Mossialos E. COVID-19 vaccine challenges: What have we learned so far and what remains to be done? Health Policy. 2021;125(5):553-567. doi:1016/j.healthpol.2021.03.013
  67. Morgan W. Anti-Vaxxers Are Weaponising the Vaccine Hesitancy of Black Communities. The Conversation; 2021.
  68. Warnick B. The narrative paradigm: another story. Q J Speech. 1987;73(2):172-182. doi:1080/00335638709383801
  69. Urrutia ML. COVID Data is Complex and Changeable–Expecting the Public to Heed it as Restrictions Ease is Optimistic. The Conversation; 2021.
  • Receive Date: 16 July 2022
  • Revise Date: 18 November 2022
  • Accept Date: 06 February 2023
  • First Publish Date: 07 February 2023