Adapting the Narrative Engagement Scale for Unstructured Patient Audio: A Tool for Advancing Patient-Centered Research

Background: Evaluating the impact of patient narratives is essential because engagement can influence how effectively these stories achieve their intended outcomes, such as fostering empathy or identifying research priorities. Currently, a standardized method to assess engagement with unstructured patient audio narratives is lacking. We aimed to validate an adapted narrative engagement scale and examine potential differences in engagement based on storyteller demographics and health topics. Methods: We analyzed audio narratives from patients and caregivers collected by [Platform Name Blinded for Review]. Participants (n=646) shared unstructured health-related stories. We adapted the Busselle and Bilandzic narrative engagement scale, originally designed for visual media, to assess three dimensions: narrative understanding, attentional focus, and emotional engagement. Confirmatory factor analysis (CFA) was conducted on a subset of narratives (n=174) to verify the factor structure. For the remaining narratives (n=472), we calculated factor scores and performed Mann-Whitney U tests to compare engagement across demographic groups and health topics. Results: Most participants were female, White, and college-educated. The adapted scale demonstrated good psychometric properties. Overall, stories successfully maintained listener focus and were easy to understand. Demographic factors were not significantly associated with engagement scores. Notably, Narratives of COVID-19 were significantly (P<.05) easier to understand and pay attention to, but less emotionally engaging than non-COVID-19 stories. Engagement scores remained consistent across most other health topics. Conclusions: The adapted narrative engagement measure is a valid tool for evaluating unstructured patient audio stories across diverse health concerns. While the tool is broadly applicable, future efforts should focus on capturing narratives from underrepresented groups to ensure inclusivity. Leveraging this framework can help researchers systematically evaluate patient voices, ensuring they meaningfully contribute to equitable healthcare solutions.