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

Abstract

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.

Addressing obstetric violence: a scoping review of interventions in healthcare and their impact on maternal care quality

“…Thirteen of the reviewed studies employed a comparative before-and-after intervention evaluation approach (19,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). Eight studies used quantitative data (19,30,31,(35)(36)(37)(38)40), five studies used a mixed-methods approach (32-34, 39, 41) and three studies collected qualitative data (42)(43)(44). The 16 studies were geographically diverse, conducted in 9 countries: Tanzania (n = 2), Kenya (n = 1), Ethiopia (n = 3), Ghana (n = 3), Sri Lanka (n = 2), Brazil (n = 2), South Africa (n = 1), Sudan (n = 1), and Sweden (n = 1).…”

“…One study selected a sample from 30 births that had been monitored using the Federal Ministry of Health of Ethiopia (FMoH) adopted Safe Childbirth Checklist (SCC) in the previous month (31). The majority of the studies focused on healthcare providers (19,(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44).…”

“…Changes from 'a culture of dehumanization of childbirth' to 'childbirth as a transformative experience' were observed. (34,42); in-depth interviews with participants of the RMC training (43), FGDs with health professionals with experiences supporting and listening to pregnant women during community engagement activities (31).…”

Respectful Maternity Care in South Asia: What Does the Evidence Say? Experiences of Care and Neglect, Associated Vulnerabilities and Social Complexities

“…Collaborations to other sectors, policy makers and sectors needed to address the issue of domestic violence in pregnancy. Infanti, Zbikowski et al 2020 47 Sri Lanka Urban Qualitative study Physicians and nurses from hospitals Theatre technique workshops Focus groups Content analysis Participatory theatre techniques hold potential as an intervention method for preventing and addressing abuse in health care in Sri Lanka. Various institutional barriers reported – policy and accountability system to prevent abuse in health care are not detailed, nuanced, integrated or enforced.…”

Training of Health Care personnel on Obstetric Violence: An Experience in Togo using the Forum Theatre Technique

“…The participants react on the behavior of the actors, and not on the relevance of the technical gestures. Several publications in the international literature around training courses using forum theater as a tool to raise awareness of caregiver-patient and OV [12][13]15] concluded that it increased participants' ability to act on their own moral convictions and that it was an effective way to build empathy and improve team communication skills. However due to insufficient staffing levels, they did not obtain significant results in their evaluation.…”