Recognizing the importance of design, content, and delivery features of health animations for preventative health behaviours: a realist review

Background: Animated messages promoting preventative health behaviours (health animations) are prevalent globally. Health animations are visual and less reliant on language and therefore can overcome health literacy barriers and reduce health inequities. Additionally, they are easily and inexpensively shared, making them a potentially powerful tool for disease prevention.Purpose: To understand why, how, for whom, to what extent, and in which contexts health animations work to promote preventative health behaviours.Method: This realist review followed the iterative stages outlined by Pawson and was conducted in accordance with the RAMESES standards. This methodology allows for the inclusion of peer-reviewed publications and grey literature, with appraisal focusing on the relevance, rigour, and richness of included data. Evaluations of animations promoting preventative health behaviours to any age population, and employing any design or comparator were included. Data syntheses sought to produce the context-mechanism-outcome configurations, which contributed to the programme theory. International stakeholder workshops with professionals and members of the public were used to sense check findings and refine the programme theory.Results: This review included the synthesis of data from 32 animations. Design, content and delivery contexts were identified, including representing the target audience, using storytelling, evoking emotion and using a credibly perceived source, which enabled the triggering of key mechanisms of action, including transportation in the story, identification, knowledge and skills. Conclusion: Health animations can be an effective tool to promote preventative health behaviours. The findings from this review have produced research and practice recommendations for the future design of health animations.