Exploring The Potential of Visual Narratives and Interactive Gamified Communication Systems to Prevent Disease, Counter Health Misinformation, And Strengthen Public Trust in Low-Literacy Communities: A Literature Review

Abstract

This study examined the effectiveness of visual narratives and interactive gamified communication systems in improving disease-prevention knowledge, countering health misinformation, strengthening preventive behavioral intention, and enhancing public trust among low-literacy populations. A quantitative quasi-experimental pretest-posttest design was applied using three communication conditions: conventional text-based health information, visual-narrative communication, and interactive gamified visual communication. The final analytical sample comprised 396 participants, including 130 in the text-based group, 132 in the visual-narrative group, and 134 in the gamified group. Quantitative outcomes included health-information comprehension, preventive knowledge, immediate and delayed recall, misinformation recognition, risk perception, preventive behavioral intention, and public trust. The findings demonstrated significant differences across communication conditions. Post-test comprehension scores were 61.8 ± 10.1 for text-based communication, 72.9 ± 9.4 for visual narratives, and 79.6 ± 8.8 for gamified communication (p < .001). Preventive-knowledge scores similarly increased to 63.1 ± 10.5, 74.6 ± 9.6, and 81.3 ± 8.9, respectively (p < .001). Immediate recall reached 83.5 ± 8.7 in the gamified group compared with 76.8 ± 9.8 in the visual-narrative group and 64.7 ± 11.3 in the text-based group. Misinformation-recognition scores were also highest under gamification at 79.4 ± 9.3, compared with 70.8 ± 10.1 and 58.6 ± 11.2, respectively. Participants receiving gamified communication demonstrated 3.76 times greater adjusted odds of correctly identifying misleading health claims than participants receiving text-based information (95% CI [2.47, 5.72], p < .001). Preventive behavioral intention reached 4.23 ± 0.52 in the gamified group, while public trust increased to 4.02 ± 0.57. Regression models explained 58.4% of variance in preventive behavioral intention and 61.7% of variance in public trust. Overall, visual narratives substantially outperformed conventional text-based health communication, while interactive gamification generated the strongest and most persistent improvements. The findings demonstrated the quantitative value of accessible, visually structured, interactive, and feedback-oriented communication for improving health-information processing, misinformation resistance, preventive motivation, and trust among low-literacy populations.