Use of health promotion manga to encourage physical activity and healthy eating in Japanese patients with metabolic syndrome: a case study

BACKGROUND: The present case study investigated the feasibility of using manga (Japanese-style comic books) to promote physical activity and healthy eating behavior in Japanese patients with metabolic syndrome. METHODS: A one-arm pre-post intervention was conducted in a Japanese suburban community. Twenty participants with a diagnosis of metabolic syndrome were recruited via health checkups. Health promotion manga were developed by the researcher, a publishing specialist, and a professional illustrator. We measured participants’ self-reported physical activity, eating behavior, and psychological readiness to change toward engaging in healthy behavior. RESULTS: At 1 month after the intervention there were no significant differences in physical activity scores, but small positive changes in vigorous (R(2) = 0.02) and moderate (R(2) = 0.01) physical activity scores were observed. Total healthy eating behavior scores were significantly improved (p < 0.05, R(2) = 0.47). In addition, participants reported positive change in psychological readiness, such as increased intention to engage in healthy behavior, enhanced self-efficacy, and benefits of using manga. CONCLUSIONS: This study demonstrates that manga interventions have potential to encourage healthy eating in patients with metabolic syndrome. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13690-018-0273-5) contains supplementary material, which is available to authorized users.