TOP 48 - Graphic Novels for Pediatric Hypertension: Enhancing Health Literacy and Medication Adherence through Visual Storytelling

Publication Number: 1807.TOP 48

Jordy Salcedo-Giraldo, Children's National Health System, Silver Spring, MD, United States; Ana M. Montoya Zuluaga, Drexel University College of Medicine, Philadelphia, PA, United States; Sumaya Smarony, Howard University College of Medicine, Woodbridge, VA, United States; Catherine Park, Children's National Health System, washington, DC, United States; Sun-Young Ahn, Children's National Health System, Washington, DC, United States

Background: Pediatric hypertension is an underdiagnosed but significant condition that can lead to early cardiovascular disease if unmanaged. Its prevalence, particularly among youth with obesity, ranges from 3.8% to 24.8% and continues to rise. Left untreated, childhood hypertension can progress to early-onset adult hypertension, metabolic syndrome, and accelerated cardiovascular aging. Early identification and education are critical, yet traditional educational tools are frequently text-heavy or contain excessive medical terminology, limiting engagement and comprehension among younger audiences. Graphic novels offer a promising, innovative approach to improving health literacy by combining visual storytelling with relatable narratives. Prior studies have shown that graphic storytelling can improve knowledge retention, comprehension, and engagement-especially among younger audiences and non-native speakers. However, limited data exist regarding their use in pediatric patient clinical education.

Objective: The primary objective is to evaluate the effectiveness of a graphic novel intervention in improving health literacy among pediatric patients with hypertension, focusing on understanding of causes, symptoms, risks, and management strategies. Secondary objectives are to (1) assess the impact of the graphic novel on understanding the importance of medication adherence and (2) determine whether exposure to the intervention is associated with improved blood pressure control.

Design/Methods: This single-center, IRB-exempt study will enroll 100 participants from an outpatient pediatric nephrology clinic. Participants will be randomly assigned to either a control group that receives standard educational materials or an intervention group that receives the comic book "Under Pressure: A Kid Hero's Guide to Blood Pressure." Illustrations were created digitally using Procreate (A4 300 dpi canvas, RGB color profile) to ensure clarity and accessibility for pediatric audiences. Pre- and post-intervention questionnaires will be used to assess changes in knowledge and attitudes. The surveys include de-identified demographic variables, two sliding-scale knowledge items, and 11 multiple-choice questions addressing key hypertension concepts. Participants will complete the pre-questionnaire at enrollment and the post-questionnaire 30 days later by phone. Manual blood pressures will be taken pre- and post-intervention. Knowledge outcomes will be analyzed using average scores from Likert-scale items and percent correct responses, and these results will be compared using mixed-design ANOVA.

Figure 1: Cover of "Under Pressure: A Kid Hero's Guide to Blood Pressure"
Cover of the graphic novel created to help educate pediatric patients about hypertension

Figure 2: Pages 6-8 of "Under Pressure: A Kid Hero's Guide to Blood Pressure"
These pages show how the graphic novel explains hypertension to patients, including etiology, risk factors, factors that play a role in the measurement of blood pressure, and the effects of hypertension on the heart.

Figure 2: Pages 10-12 of "Under Pressure: A Kid Hero's Guide to Blood Pressure"
These pages show how the graphic novel explains the DASH diet to patients, as well as provides information on serving sizes and a sample menu patients can utilize at home to help improve their blood pressure.