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Bringing fictional characters to life: reflections on co-creating a comic book with members of the public

Cairns, Joanne Marie; Roberts, Helen; Al-Khafaji, Geraldine; Kwater, Maria


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Ms Helen Roberts
Patient and Public Involvement Coordinator

Geraldine Al-Khafaji

Maria Kwater


There are growing calls for cancer screening to become more personalised by considering a range of risk factors, rather than a one-size-fits-all, age-based approach. The aim of this public involvement was to co-create a comic book about bowel cancer screening to be used as a visual elicitation tool in research focus groups with members of the public and healthcare professionals, as part of the At Risk study, to discuss their attitudes toward personalised bowel cancer screening, which would involve considering different risk factors. This article critically reflects on the co-creation process to develop the comic book, benefits and challenges, and some lessons learned to inform other researchers considering a similar approach. In total, ten public contributors (5 men and 5 women) from two public involvement networks participated in two successive online workshops to develop six fictional characters, two for each level of bowel cancer risk (low, moderate and high risk). This tool was then used in the At Risk study comprising five focus groups involving 23 participants, including members of the public (n = 12) and healthcare professionals (n = 11). The co-created comic book was a generally well-received research tool able to generate discussion about a complex topic, bowel cancer risk, in an accessible way. It was suggested that the comic book may also be extended beyond the research context to inform bowel cancer screening decisions and raise awareness of risk factors.


Cairns, J. M., Roberts, H., Al-Khafaji, G., & Kwater, M. (2023). Bringing fictional characters to life: reflections on co-creating a comic book with members of the public. Research Involvement and Engagement, 9(1), Article 28.

Journal Article Type Article
Acceptance Date Apr 18, 2023
Online Publication Date May 2, 2023
Publication Date Dec 1, 2023
Deposit Date May 2, 2023
Publicly Available Date May 2, 2023
Journal Research Involvement and Engagement
Print ISSN 2056-7529
Electronic ISSN 2056-7529
Publisher Springer Verlag
Peer Reviewed Peer Reviewed
Volume 9
Issue 1
Article Number 28
Keywords Public involvement; Bowel cancer; Screening; Comic; Visual elicitation; Co-creation
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© The Author(s) 2023.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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