A Mixed-method Analysis of Community-Engaged Theatre Illuminates Black Women’s Experiences of Racism and Addresses Healthcare Inequities by Targeting Provider Bias

Abstract

Theatre has been a powerful means of eliciting social change. This paper describes methods and outcomes of a theatre project to reduce healthcare inequities experienced by Black women. We conducted narrative interviews with a convenience sample of Black women and conducted thematic analysis of interview transcripts to learn about their experiences of healthcare and to inform development of a professional theatrical production. To assess the impact of the performance on the audience, we used a single post-test concurrent mixed-methods design using a self-created Likert-type survey that included space for open-ended responses. Ten Black women completed narrative interviews. Thematic analysis revealed 5 main themes: being ignored, being accused, being talked-down to, fearing harm, and being hurt. Narratives were used to create a script that centered on these themes, and that was professionally produced and performed. Audience members (n = 113, 25% healthcare providers) produced a mean total post-test score of 19.28 (agree/strongly agree) on a 25-point survey with 2 items scoring in the 2 to 3 range (disagree/not sure). Thematic analysis data revealed the extent to which Black women experienced discrimination in multiple settings. Quantitative survey data suggested audience members conceptually understood and were aware of inequity, but open-ended responses revealed this information was new for some, and prior knowledge for others. The audience reported planning to change personal behaviors that may contribute to inequity. Participants were unsure if they had contributed to inequity in the past. The performance stimulated conversation about implicit bias and discrimination and encouraged audience members to examine their contributions to the problem. Future pre-post studies are needed to better assess the impact of the performance. Theatre has the potential to illuminate the extent and nature of discrimination in healthcare and society, and to foster conversations that allow audience members to consider their own potential contributions to discrimination.

Determining the Factors That Influence Stunting during Pandemic in Rural Indonesia: A Mixed Method

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Protocol for evaluating external facilitation as a strategy to nationally implement a novel stigma reduction training tool for healthcare providers

“…IDEAS is a one-hour, client-centered, occupation-based, theatre intervention to reduce stigma beliefs among healthcare providers [3,4]. IDEAS performances are created by conducting narrative interviews with people from a target population who have been harmed by provider stigma and translating those narratives into a theatrical performance to be performed by professional actors for healthcare providers.…”

“…An IDEAS performance is an opportunity to attune to and witness others' stories. Attending to stories through theatre provides viewers with an opportunity to privately witness and confront their own implicit biases [3,4]. By becoming aware of and grappling with one's own biases, viewers gain flexibility regarding how they respond to those biases in the moment with clients, co-workers, and people in general [9].…”

“…A critical barrier to progress in occupational therapists' ability to promote equity in health care is the limited availability of evidence-based approaches occupational therapists can implement to support occupational justice. To address this gap, external facilitation will be used to disseminate Identity Development Evolution and Sharing (IDEAS), a program for reducing healthcare provider stigma, with a growing body of supporting evidence [3,4]. This manuscript describes (1) the IDEAS intervention, (2) the planned implementation and implementation evaluation; and (3) provides a narrative review of how provider stigma may lead to healthcare inequity and health disparities.…”

Defining and finding an endgame in education on race

“…A continued reliance solely on the classroom, panels, forums, and the like as spaces for dialogue on race will continue to silo discussions and preclude cross-cultural exposures within academia and between academia and the general population. To this end, going beyond oral histories, testimonios can also focus on spoken word, poetry, as well as acting, art therapy, and other forms of creative communication (Kobin and Tyson, 2006; McGann, 2006; Sajnani, 2012; Wasmuth et al, 2020). In this way, nontraditional education can advance empathy-focused education by utilizing materials and media that are grounded in the indigenous traditions of racial/ethnic minorities and that may thus allow for richer, more nuanced engagements.…”