Table 2 Summaries of main emerging themes elicited during in-depth interviews

Glocalization

The majority of respondents, in both interviews and open-ended survey comments, expressed that the simplification of character and setting representations was acceptable to them and an effective strategy for designing visuals that would resonate cross-culturally, (ie: Respondent from North America: “Characters with no faces is helpful. Then you don’t take time trying to figure out what they look like.”)

Several respondents suggested that simpler visual representations of characters facilitated the individual viewer’s projection of familiar identifiers onto the characters, (ie: Respondent from Latin America: “It’s better if you don’t relate any skin color so that anyone can feel related … When the people were in colors - like blue - and the ones that were in simple shapes, that was very universal. I think Mercury is the best.”) A few respondents felt that extremely simple character representations might not be able to elicit the level of identification needed to transport the viewer in a way that facilitates audience engagement. Most respondents felt that the use of compelling voiceovers and narratives could help to overcome the challenges associated with simple, universally applicable imagery, (ie: Respondent from the North America: “Images should be as ‘neutral’ and universal as possible, but the voiceover and the webpage… should be specific to the target audience.”)

In China, one respondent noted that videos reflecting obviously foreign characters and settings might elicit positive, aspirational sentiments, compared with those that are universal or familiar to the viewer. This hypothesis was not echoed by respondents in other countries. In both in-depth interviews and open-ended survey feedback, the prototypes that incorporated ethnic identifiers were more likely to be preferred within regions where those identifiers were felt to be familiar, but less preferred for global resonance, (ie: Respondent from Eastern Europe: “I work with international people… but I remember some African pictures in [the survey]. I loved them but I don’t know how others might take that. Perhaps more universal pictures are better for everyone.” Respondent from Egypt: “these parents don’t look like ours so it’s not for my country.”)

Color

In general, respondents expressed a preference for high contrast or bright, solid colors as a means of supporting viewer engagement, (ie: Respondent from SE Asia: “Some of them appeared to be gloomy and some of them appeared to be vibrant to me. The grey colors were feeling a little dull.”)

Bright colors were also suggested way of making content accessible to those in need of visual accommodations, (ie: Respondent from Western Europe: “I prefer high contrast colors because these can also help to account for various disabilities.”) Respondents from different regions mentioned region-specific associations with select colors that should be taken into account when deciding on a universal color palate, (ie: Respondent from SE Asia: “Red is associated with death in Korea.”)

Family portrayals

Several respondents reflected on the importance of considering the potential variation in portrayals of “typical family” structures and depiction of traditional roles. This was specifically referenced with regard to gender norms regarding child caregiving roles. Respondents in both the interviews and qualitative feedback sections of the survey expressed a preference for inclusive representations of diverse family structures, (ie: Respondent from South SE Asia: “It should reflect the different family roles in different places. Grandparents do the bulk of child-rearing in South Korea, so family dynamics might look different….Men are more open to messages that they should invest more time and energy in parenting.”)

Voice

In general, respondents felt voiceovers should ideally be tailored to align closely with both local language and familiar-sounding voices in order to optimally enhance learner identification and engagement with the content. A minority of respondents expressed a fascination with the novelty of an unfamiliar accent but qualified this by noting that they felt many people would stop listening or dismiss messages delivered by a narrator with an unfamiliar accent. Many respondents felt that featuring a child’s voice within the narration was compelling, (ie: Respondent from SE Asia: I felt the energy of the child voice was good…. The voice of the child creates a good mood and resonates well because it has a good energy... The child can be the agent of change.)

Other perceived benefits, noted by respondents, included: a) the neutrality/innocence of the child’s voice, b) the feeling that a child’s voice was considered “cute” and was therefore potentially less patronizing or directive than instructions coming from an adult. A minority of respondents felt that a child should only narrate videos for other children as a child’s voice would not carry the same authority as an adult’s voice.

Use of narration/stories

A majority of respondents expressed a preference for a narrative approach to instruction vs. a more traditional approach focused on simply relaying information, (ie: Respondent from Eastern Europe: “It’s a little bit boring when it is just a person telling you information.”)

These respondents felt that simple animations were effective as supporting visuals for narratives and could more effectively be universalized, while the voice of the narrator should ideally be tailored to the region.

Video length

In general, respondents expressed a preference for short (2-5 min) videos for health communication purposes, with no more than 2–3 key messages per video, (ie: Respondent from North America: “health messaging of this sort… can only be a couple of minutes long with, ideally, 2–3 messages.”)