Electronic Theses and Dissertations



Document Type


Degree Name

Doctor of Education


Instruction & Curriculum Leadership

Committee Chair

Andrew Tawfik

Committee Member

Craig Shepherd

Committee Member

Scott Vann


Asynchronous multimedia learning is a common form of delivering training in the workforce industry, and organizations rely on a completion status to measure that training. However, measuring retention and knowledge transfer of new material rarely occurs during asynchronous learning. Grounded in the Visual Language Theory (VLT) and a delivery modality of digital storytelling (DST) suggest that sequential images presented as a visual narrative have higher degrees of retention. Thus, knowledge transfer occurs when learners relate to the narrative and visual applications when engaging with a comics approach to learning. From 2019-2022 a story emerged to design and develop an asynchronous digital storytelling comic narrative about simulation obstetrics training for distribution to 700 nurses in Bihar, India. Chapter 1 introduces digital storytelling and the use of comics in medical education. Chapter 2 explores the literature around visual language theory, digital storytelling, and andragogy in comics. Chapter 3 investigates the initial design beginning in 2018 with the implementation study, to the Simulation Educator Training redesign in 2019. A thorough needs assessment introduces Chapter 4 with learner and context analysis, exposing communication barriers, culture representation, character development, and technology challenges. The initial deployment and subsequent feedback survey in late 2019 resulted in a major redesign beginning in 2020. The following two years resulted in ten comic episodes with shorter seat time, more in-depth explanations of abstract concepts, and interactive scenarios to practice real-world situations. Chapter 5 concludes with lessons learned, opportunities, and closing with the results of a final study conducted in late 2021 and published in February 2022 in the International Journal of Environmental Research and Public Health, resulting in an 86% increase in retention.


Data is provided by the student.

Library Comment

Dissertation or thesis originally submitted to ProQuest


Open Access