Can Forum Play Contribute to Counteracting Abuse in Health Care? A Pilot Intervention Study in Sri Lanka

Swahnberg, Katarina; Zbikowski, Anke; Wijewardene, Kumudu; Josephson, Agneta; Khadka, Prembarsha; Jeyakumaran, Dinesh; Mambulage, Udari; Infanti, Jennifer J.

doi:10.3390/ijerph16091616

Cited by 18 publications

(23 citation statements)

References 34 publications

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“…Our results are consistent with research confirming that role-playing is an effective way to enhance empathy and to improve the communication skills of health professionals [ 29 , 30 ]. They also support the findings that showed that participants in FP workshops had experienced a change in their motivation and perceived ability to act in situations of AHC [ 31 , 32 , 33 ]. However, while these studies gave reason to assume that FP workshop training increased the awareness of AHC as a shared problem, such a change could not be seen in the quantitative evaluation presented in this article.…”

Section: Discussionsupporting

confidence: 82%

Counteracting Abuse in Health Care: Evaluating a One-Year Drama Intervention with Staff in Sweden

Zbikowski

Brüggemann

Wijma

et al. 2020

IJERPH

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In Northern European countries 13–28% of female patients seeking gynecological health care have reported abuse by health care staff (AHC). We conducted workshops with health care staff using the improvised role-play method Forum Play (FP), based on techniques developed by Boal. The study explores to what extent the intervention increased the staff’s awareness of AHC and their ability to take action against it. A total of 16 half-day FP workshops were conducted with staff from a Swedish women’s clinic over one year. Self-reported questionnaires were distributed to all staff before, during, and after the intervention. Primary outcome measures were the number of reported occasions of AHC and FP participants’ ability to act in AHC-situations. We found an increase in the participants’ self-reported ability to act in AHC-related situations. However, no change could be observed in the number of reported occasions of AHC between baseline and one year after the intervention. Health care staff’s participation in workshops using improvised role-play can increase staff’s perceived ability to take action in AHC situations. The voluntary nature of the intervention may have attracted those who were already aware of the topic, and likely explains the unchanged awareness of AHC.

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Section: Discussionsupporting

confidence: 82%

Counteracting Abuse in Health Care: Evaluating a One-Year Drama Intervention with Staff in Sweden

Zbikowski

Brüggemann

Wijma

et al. 2020

IJERPH

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“…In Sri Lanka, multi-professional teams provide maternity care; in our study setting, physicians and registered nurses are the primary health providers during childbirth. Twenty physicians and 30 nurses participated in the workshops [ 39 ].…”

Section: Methodsmentioning

confidence: 99%

“…Figure 1 is an example of one of the situations of AHC identified by the participants based on personal experiences that we explored in a workshop. Our prior publication on this pilot intervention contains an additional example and further details about the methodology [ 39 ].…”

Section: Methodsmentioning

confidence: 99%

“…For this study, we adapted the intervention for use with health care providers involved in maternity care in Sri Lanka. Our previous article [ 39 ] demonstrates the potential effectiveness of the FP intervention in Sri Lanka to increase participant’s knowledge and recognition of AHC. This was indicated by participants more often reporting they had been personally involved in situations of AHC three-to-four months after the workshops compared to before.…”

Section: Introductionmentioning

confidence: 99%

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Feasibility of Participatory Theater Workshops to Increase Staff Awareness of and Readiness to Respond to Abuse in Health Care: A Qualitative Study of a Pilot Intervention Using Forum Play among Sri Lankan Health Care Providers

Infanti

Zbikowski

Wijewardene

et al. 2020

IJERPH

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Women globally experience mistreatment by health providers during childbirth. Researchers have identified strategies to counteract this type of abuse in health care, but few have been evaluated. We used a theater technique, Forum Play, in a brief training intervention to increase awareness of abuse in health care and promote taking action to reduce or prevent it. The intervention was implemented in four workshops with 50 participating physicians and nurses from three hospitals in Colombo, Sri Lanka. This article reports the views of 23 workshop participants who also took part in four focus group discussions on the acceptability and feasibility of the method. The participants reported that the intervention method stimulated dialogue and critical reflection and increased their awareness of the everyday nature of abuses experienced by patients. Participants appreciated the participatory format of Forum Play, which allowed them to re-enact scenarios they had experienced and rehearse realistic actions to improve patient care in these situations. Structural factors were reported as limitations to the effectiveness of the intervention, including under-developed systems for protecting patient rights and reporting health provider abuses. Nonetheless, the study indicates the acceptability and feasibility of a theater-based training intervention for reducing the mistreatment of patients by health care providers in Sri Lanka.

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“…A growing body of evidence shows that the implementation of specialized respectful maternity care programs and interventions that positively in uence the attitude and response of maternity care providers are generally effective in reducing the rate of mistreatment of childbearing women during intrapartum care services in developing countries [9][10][11][12][13][14][15]. Some of these programs and interventions include theatrebased training interventions to reduce obstetric violence [14], monitoring of midwives during practice [9], improvement in working conditions of healthcare providers [11], equipping midwives with the ability to identify and manage obstetric and neonatal emergencies [16], and the training of midwives to effectively communicate with clients [10,17].…”

Section: Introductionmentioning

confidence: 99%

Midwives’ experiences of implementing respectful maternity care knowledge in daily maternity care practices after participating in a four-day RMC training

Dzomeku

Mensah

Nakua

et al. 2020

Preprint

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Background: In Ghana, studies documenting the effectiveness of evidence-based specialized training programs to promote respectful maternity care (RMC) practices in healthcare facilities are few. Thus, we designed a four-day RMC training workshop and piloted it with selected midwives of a tertiary healthcare facility in Kumasi, Ghana. The present paper evaluated the impact of the training by exploring midwives’ experiences of implementing RMC knowledge in their daily maternity care practices four months after the training workshop.Methods: Through a descriptive qualitative research design, we followed-up and conducted 14 in-depth interviews with participants of the RMC training, exploring their experiences of applying the acquired RMC knowledge in their daily maternity care practices. Data were managed and analysed using NVivo 12. Codes were collapsed into subthemes and assigned to three major predetermined themes.Results: The findings have been broadly categorized into three themes: experiences of practising RMC in daily maternity care, health facility barriers to practising RMC, and recommendations for improving RMC practices. The midwives mentioned that applying the newly acquired RMC knowledge has positively improved their relationship with childbearing women, assisted them to effectively communicate with the women, and position them to recognize the autonomy of childbearing women. Despite the positive influence of the training on clinical practice, the midwives said the policy and the built environment in the hospital does not support the exploration of alternative birthing positions. Also, the hospital lacked the required logistics to ensure privacy for multiple childbearing women in the open labour ward. The midwives recommended that logistics for alternative birthing positions and for privacy in the ward should be provided. Also, all midwives and staff of the hospital should be taken through the RMC training program to encourage good practice.Conclusion: Despite the report of some RMC implementation challenges, the midwives noted that the 4-day RMC training has had a positive impact on their maternity caregiving practice in the hospital. Policies and programs aimed at addressing the issue of disrespect and abusive practices during maternity care should advocate and include the building of facilities that support alternative birthing positions and privacy of childbearing women during childbirth.

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Can Forum Play Contribute to Counteracting Abuse in Health Care? A Pilot Intervention Study in Sri Lanka

Cited by 18 publications

References 34 publications

Counteracting Abuse in Health Care: Evaluating a One-Year Drama Intervention with Staff in Sweden

Counteracting Abuse in Health Care: Evaluating a One-Year Drama Intervention with Staff in Sweden

Feasibility of Participatory Theater Workshops to Increase Staff Awareness of and Readiness to Respond to Abuse in Health Care: A Qualitative Study of a Pilot Intervention Using Forum Play among Sri Lankan Health Care Providers

Midwives’ experiences of implementing respectful maternity care knowledge in daily maternity care practices after participating in a four-day RMC training

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