JMIR Publications

ABSTRACT

Background:

Animated messages promoting preventive health behaviors (health animations) are a prevalent form of digital health communication globally. Health animations are visual and less reliant on language, helping to reduce health literacy barriers and health inequities. Evidence suggests that animations can be effective in health and non-healthcare settings, however, the causal mechanisms at work are unknown.

Objective:

To understand why, how, for whom, to what extent, and when health animations work to promote preventive health behaviors.

Methods:

This realist review was conducted in accordance with the RAMESES standards. Peer-reviewed publications identified through database searching from inception until 27 April 2025 and gray literature were considered for inclusion. Animations promoting preventive health behaviors in any population and evaluations employing any design were included. Animations that could not be viewed, were designed to treat illness or disease, or were part of a multicomponent intervention were excluded. Data were appraised for their relevance, rigor, and richness. Data syntheses sought to produce context-mechanism-outcome configurations, contributing to a program theory of health animations. International stakeholder workshops with professionals and members of the public were used to sense check findings and refine the program theory.

Results:

This review synthesized data from 48 health animations. Design, content and delivery constructs were identified, including audience/challenge representation, using storytelling, evoking emotion and accessibility. These contexts enabled the triggering of key mechanisms, including identification, transportation into a story, knowledge, self-efficacy, and cognitive processes. The dataset for this review was limited by a lack of access to some animations. Additionally, due to a lack of data on behavioral outcomes in the identified literature, our program theory primarily reflected mechanisms influencing behavioral determinants.

Conclusions:

Health animations can be an effective tool to promote key determinants of preventive health behaviors, however, whether they can also promote behaviors remains unclear. The likely contexts and mechanisms at work in determining the effects of health animations on desired outcomes should be considered during the design and development process. A set of 10 recommendations are provided to this end. Clinical Trial: Review registration: PROSPERO CRD42023447127.