This paper gives a perspective on PA as a unique opportunity to break down barriers in traditional health research. It highlights its potential as an innovative approach in health promotion geared towards comprehensive intervention design and implementation. Its future directions include refining intervention strategies based on community feedback to sustain engagement and enhance health outcomes.

More specifically, this work is best understood as a conceptually grounded synthesis, integrating existing literature with illustrative examples drawn from prior studies. While no new primary data were collected, the analysis was informed by participatory design principles and grounded in empirical case applications from the field.

PA is a methodological and cultural practice centered on the co-creation of animated content [27]. This approach has two key affordances: (1) the co-production process illuminates inherent relational and dialogical processes between participants and researchers, and (2) the resulting animations can serve as multimedia tools to enhance DHI outcomes [48,58]. Indeed, animation as a participatory practice has been effective for digital health promotion, including areas in community wellness [59], building healthy interpersonal connections [60,61], developing culturally responsive therapeutic practices [62], and fostering safety and belonging for refugee children [63]

Animation as a medium illustrates a unique potential for community engagement. It is defined as “any application that generates a series of frames, with each frame appearing as a modification of the previous one,” where each sequence or narrative is determined by the designers [28,29]. Animation can break down the barriers of written text, making content accessible, and can be culturally tailored to reflect the lived experiences of specific target populations. Its iterative nature also allows for ongoing input and refinement, enabling participants to co-construct meaning through a combination of oral and visual storytelling.

The development of animated content can foster civic engagement by empowering community partners to share their experiences, perspectives, and ideas. PA brings together diverse forms of experiences, knowledge, and skills, creating opportunities to explore multilevel health determinants through collaborative design [26,57,64,65]. The production process integrates various artistic and linguistic forms, including creative writing through script development, sound and music composition, and visual design such as character modeling and background art. The multidimensional input not only amplifies participant voices but also enables researchers to gather intersecting forms of data, thereby enhancing the richness of analysis and opportunities for data triangulation.

PA can semiotically manifest an individual’s experience by empowering community partners to shape their self-presentation, offering narrative control [27]. Animation production can democratize the research process, countering traditional models in which participant voices are often filtered through external interpretation [66,67]. By fostering collaboration and mutual respect, PA can also serve as a mechanism for building trust between community partners and researchers [68]. For example, Lomax and Smith [27] used animation to capture children’s emotional experience during the COVID-19 lockdown. The use of participant-generated voiceovers preserved nuance, such as humor and tone, not easily conveyed through transcripts. Similarly, Massijeh [63] used animation as a tool for play and exploration with South Sudanese refugee children, enabling them to articulate ideas that may have been inaccessible through traditional methods. These examples highlight how PA can enrich data collection and enhance the relevance of formative assessment [69].

Indeed, participatory practices can help address the limitations of traditional qualitative methods like focus groups and interviews. Animation can enhance communication by capturing emotional nuance, symbolic meaning, and complex messages that may be difficult to articulate through verbal methods alone. It can also overcome language barriers, offering a meta-narrative format that converts ideas visually and universally. Vaughn and Jacquez [15] demonstrated this effectively in their community-based project with youth partners aimed at reducing violence and promoting neighborhood well-being. Their iterative process, involving story vignettes, storyboarding, voiceover recordings, and animated revisions, revealed facilitators that may have been overlooked through conventional research, such as the partners’ preference for visually appealing, short-form messaging tailored to peer audiences.

PA can be used to explain causal relationships and pathways, whether through multilingual assessments or empirical testing of its messaging effects. Offering multiple textual domains—visual, auditory, and narrative—this approach enables the exploration of complex social structures that may be inaccessible through more traditional or unidimensional methods. For instance, Janssen et al [70] documented how employees used animation to simulate organizational processes and support the adoption of shared services. Their participatory process created a direct pipeline from data collection to content creation, culminating in a film presented to stakeholders for evaluation. As a determinant of efficiency in the business setting, animation, in this case, is used as a participatory praxis to assess causal links while providing a product to engage clients.

Finally, PA also serves as an effective and timely tool for disseminating health messages to diverse community segments. Research indicates that animation can enhance DHI structures and enhance messaging, particularly through widely used digital devices, including smartphones, tablets, and social networking sites [30,31]. Vaughn and Jacquez [15] collaborated with community members to develop violence-prevention animations, which were strategically shared through social networking channels to maximize relevance and reach. This approach illustrates how PA can extend the lifecycle of community-driven interventions beyond the research setting and into everyday digital environments. Here, they co-produced violence-prevention animated content with residents and disseminated it to targeted social networking outlets.

Overall, PA can be understood along 2 key dimensions: as a process and as a product. As a process, this method involves iterative collaboration with community members through processes such as scripting, voiceover development, storyboarding, and visual design, a creative cycle that fosters trust, reflection, and shared meaning-making. As a product, the resulting animated content serves as a multimodal tool for intervention delivery, communication, or knowledge dissemination. This distinction is critical: the process facilitates engagement and data generation, while the product enhances message clarity and reach. Recognizing both dimensions helps researchers design PA projects that are both methodologically rigorous and practically impactful [27,48,59].

It is important to note that PA shares similarities with other participatory visual methods such as photovoice, participatory video, and theater. Scholars and practitioners have used these methods to center community voices, facilitate collective reflection, and aim to shift power, if not democratize, research processes. However, PA offers distinct affordances. Unlike photovoice, which relies on still imagery, or participatory video, which typically requires synchronous participation and access to equipment, animation allows for asynchronous collaboration. Here, community members can contribute ideas, voiceovers, or drawings through diverse and flexible timelines. Compared to theater, which foregrounds live embodiment and performance, PA can preserve anonymity and privacy, which may be especially valuable in stigmatized health contexts. Moreover, its multimodal nature—blending sound, image, text, and movement—makes it uniquely suited for communicating complex, layered health determinants across digital platforms. Indeed, these affordances specifically position PA as a scalable and context-sensitive approach for DHI development, particularly for and by communities with varying levels of technological and physical access.

PA is supported by multiple theoretical frameworks that underscore its value for advancing DHI research and practice (Table S2 in Multimedia Appendix 1). From a dialogical framework perspective, animation production unfolds through a series of phases that enable diverse modes of reflection and communication. Indeed, “much of the work [in animation development] occurs under closed doors and is made of incredibly complex intersubjective exchanges, negotiations, and contestations,” offering rich opportunities to collect and assess complex health determinants [71]. Within this framework, PA can help address what Bourdieu et al [72] termed the ‘paradox of communication’ or the difficulty of conveying lived experience within dominant linguistic or symbolic structures. As Frank argues [73], dialogical narratives are especially valuable for disrupting hegemonic frames and making space for alternative or marginalized forms of expression.

The multimodal nature of animations allows for the transmission of rich, layered information shaped by its creators. Frank’s dialogical narrative analysis [73] provides a useful lens for understanding this potential, emphasizing the value of examining tensions across different communication modes. His framework identifies 3 distinct publics that help explore the association between visual storytelling and community output evaluation. The first public comprises the core group of participants and researchers or filmmakers, fostering idiosyncratic relationships. The second public includes individuals outside the research project who clearly understand its context and have indirect connections, such as film viewers. The third public, a broader audience, views the film independently and lacks the opportunity for direct engagement or participation in an intersubjective process. This 3-tiered model supports a comprehensive exploration of animation’s communicative reach and highlights its potential to foster engagement and meaning-making across multiple levels of audience participation.

Animation alone is supported by numerous cognitive theories that can bolster DHIs’ structures. It is supported by the cognitive theory of multimedia learning proposed by Mayer and Moreno [74]. This theory posits that learners engage in three critical cognitive processes when exposed to multimedia content that incites auditory and visual sensations: (1) incoming verbal information to create text schema, (2) incoming visual information to form an image base, and (3) a combination of verbally and visually based models which enhance knowledge acquisition, a variable shown to encourage prohealth behaviors [75]. Cognitive scholars Berney and Bétrancourt [76] found this framework helpful for understanding animation’s empirical effects in enhancing participant learning across 50 studies compared to static illustration. These animations simultaneously presented verbal and visual materials that enhanced participant knowledge on the subject.

The social cognitive theory, developed by Bandura [75], further reinforces the value of animation in enhancing DHIs. This theory posits that individuals acquire knowledge not only through direct experience but also by observing others, whether through social interactions or mediated representations. When paired with the cognitive theory of multimedia learning, animations become a powerful tool for modeling behavior, allowing users to visualize actions, consequences, and strategies in ways that support observational learning. O’Day [77] elucidates animation’s effects in enhancing modeling structures, where teaching procedural information through dynamic events was more effective than static sequential images.

The cognitive load theory also supports the strategic use of animation in DHIs [78]. This theory emphasizes the limitations of working memory and the importance of minimizing extraneous cognitive demands to facilitate learning and long-term retention. Animation can reduce cognitive load by integrating visual and verbal information in a way that supports comprehension. For instance, animation that includes complementary text content congruent to the targeted message and signaling cues (eg, highlighting, arrows, and flashing symbols) helps direct user attention and reinforce key concepts [79,80]. These features enable users to process complex information more effectively, thereby improving message clarity and enhancing prohealth outcomes [81].

Overall, PA leveraged across numerous research capacities, contingent upon the researcher’s epistemological perspective. Researchers may opt for a critical, interpretative, practical, or positivist approach.