Adapting the narrative engagement scale for unstructured patient audio: a tool for advancing patient-centered research

Abstract Background Patient narratives often aim to foster empathy, sustain attention, and translate lived experiences into patient-centered research priorities; however, while the content of these stories has been widely examined, audience engagement, which can influence whether narratives achieve these aims, has received less attention. Currently, a standardized method to assess engagement with unstructured patient 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 preliminary evidence of acceptable psychometric performance. Overall, stories were rated as easy to understand and able to maintain audience focus. Demographic factors were not significantly associated with engagement scores. Notably, narratives of COVID-19 were significantly easier ( p <0.05) to understand and pay attention to, but less emotionally engaging than non-COVID-19 stories, whereas injury- or wound-related narratives elicited higher emotional engagement. Engagement scores remained consistent across other health topics. Conclusions This study provides preliminary validation evidence for the adapted narrative engagement measure for evaluating audience engagement with unstructured patient audio narratives across diverse health concerns. Future efforts should focus on capturing narratives from underrepresented groups to strengthen generalizability. This adapted measure can help researchers systematically evaluate not only what patient stories communicate, but also how audience understand, attend to, and emotionally engage with those stories, supporting the meaningful use of patient narratives in patient-centered research.