Enacting change: using Forum Theatre to improve post-injury psychological care

Kate Beckett and Toity Deave

This blog post is based on the Evidence & Policy article, ‘Using Forum Theatre to mobilise knowledge and improve NHS care: The Enhancing Post-injury psychological Intervention and Care (EPPIC) study‘, part of the Special Issue on Creativity and Co-production.

We know that physical trauma causes psychological problems. The evidence suggests that around 30% of injured adults will develop a psychological problem such as Post Traumatic Stress Disorder within twelve months of injury and these have a significant impact on their recovery. Despite this, NHS management of trauma patients’ psychological needs is generally poor, which leads to under-recognition, delayed treatment, and increased individual, societal and healthcare costs.

The inability of this evidence to directly influence practice is symptomatic of a broader concern about the generation and uptake of research. It goes to the heart of how we perceive human health and healthcare (and the interplay between physical, social, and psychological factors), how we produce knowledge to shape and change it, and how we understand the way knowledge is effectively transmitted in practice. Our study, as published in a recent Special Issue of Evidence & Policy, used innovative methods to address these wider challenges and improve post-injury psychological care.

The Enhancing Post-injury psychological Intervention and Care (EPPIC) study was a collaborative enterprise involving NHS patients, practitioners and researchers from the start. We combined patient, practitioner and research evidence about the psychological impact of injury and NHS trauma care and conveyed this rich blended evidence in a play called ‘Altered States’.

We presented the play at workshops using Forum Theatre – a form of participatory drama – to stimulate debate and catalyse change. This helped audiences of the same three stakeholder groups to share their knowledge and actively co-produce innovative solutions.

Our findings illustrated the strengths and limitations of different forms and sources of evidence, and showed how they can be combined and brought to life through drama. This rendered the data more real, accessible and relatable to the realities of NHS care. It encouraged stakeholders to consider tensions between individual needs and contextual realities, the scientific evidence and what matters for patients’ experiences of care.

Presenting these data as a story, and bringing diverse stakeholders together, had a marked impact on the individuals involved and on relationships between stakeholder groups. It provided a powerful reminder that healthcare practice is essentially made up of human interaction between individuals giving and receiving care. By illustrating different stakeholders’ aspirations and the numerous barriers to achieving them, EPPIC stimulated mutual understanding, creativity and momentum for change. This, in turn, led to multilevel changes in behaviour, practice and research.

Our article explores EPPIC’s methods, impact and mechanisms, and draws on diverse findings from the knowledge mobilisation field and performative arts. It shows how understanding ‘clinical mindlines’, i.e. the forms of knowledge required for effective practice and how they are transmitted, can enhance the impact of research. It reminds us that scientific evidence cannot improve patient outcomes and experience on its own.

Our study makes a novel contribution to the expanding literature by showing how co-production and creativity can help bridge gaps between evidence, knowledge and action. It adds to this Special Issue collection of articles by passionate people using co-production and creativity to address complex often-intractable, high-stake social issues, and tackle the wider challenges of implementing research – articles which, though addressing different topics, agree on the need for diverse forms of knowledge and the potential of creative practices to give voice to the vulnerable and mitigate power imbalances.

The challenges of achieving co-production, selling creative approaches and demonstrating their value to funders are also explored. Together, these articles represent a clarion call for a new form of research that embraces tensions between diverse voices and realities, and uses creative means to bring the issues alive, reveal the human tragedy of inaction and engender multi-level momentum for change.

For more information on EPPIC, see: https://www.uwe.ac.uk/research/centres-and-groups/chcr/research-themes/knowledge-mobilisation/eppic.

Kate Beckett is Senior Research Associate at the Bristol Medical School at the University of Bristol (epkeb@bristol.ac.uk), and Visiting Research Fellow at the University of the West of England, Bristol (kate2.beckett@uwe.ac.uk).

Toity Deave is Associate Professor for Family & Child Health at the Centre for Academic Child Health in the School of Health and Social Wellbeing at the University of the West of England Bristol (toity.deave@uwe.ac.uk).

You can read the original research in Evidence & Policy:

Beckett, K. Deave, T. McBride, T. le May, A. Gabbay, J. Kapoulas, U. Long, A. Warburton, G. Wogan, C. Cox, L. Thompson, J. Spencer, F. and Kendrick, D. (2022). Using Forum Theatre to mobilise knowledge and improve NHS care: the Enhancing Post-injury Psychological Intervention and Care (EPPIC) study. Evidence & Policy, DOI: 10.1332/174426421X16420902769508. OPEN ACCESS

Image credit: Photo by Unknown Author. Licensed under CC BY-SA-NC.

If you enjoyed this blog post, you may also be interested to read:

Improving knowledge mobilisation in healthcare: a qualitative exploration of creative co-design methods OPEN ACCESS

Creative processes in co-designing a co-design hub: towards system change in health and social services in collaboration with structurally vulnerable populations OPEN ACCESS

Creative and collaborative reflective thinking to support policy deliberation and decision making OPEN ACCESS

Disclaimer: The views and opinions expressed on this blog site are solely those of the original blog post authors and other contributors. These views and opinions do not necessarily represent those of the Policy Press and/or any/all contributors to this site.

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