Sullivan J, Stanford M; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 4109.
NIEHS / Sealy Center for Environmental Health & Medicine , Preventive Medicine / Community Health, 301 University Blvd., Galveston, TX 77555-1071 Tel. 409-747-1246 Fax 409-772-1790
RESEARCH OBJECTIVE: Purposes of the Forum included: 1) using images and performative tools of TO to analyze social, economic and cultural implications of health care disparities, 2) framing issue experientially to illustrate impacts of service denial, and encourage audience empathy, 3) using interactive facets of TO to encourage participatory dialogue and problem-solving among audience members and performers. (Dialogue was expressed as actions by audience volunteers who entered scene(s), replaced the oppressed protagonist or allied with protagonist, and proposed solutions through stage actions.) STUDY DESIGN: A workshop convened for training in Theatre of the Oppressed dramaturgy. Participants learned: 1) how image tableaus may represent affective and conceptual elements of the issue, 2) uses of dramatic structure to sequence and focus personal stories, 3) development of scenarios through improvisation, 4) uses of special structures to deconstruct significance of scenic actions, and 5) using audience interaction to invite dialogue, novel actions and processing of spectator interventions. The show was performed for community members in an informal space, using an issue-specific sociometric exercise as a warm-up. Audience selected one scene for the Forum process, and spectators initiated interventions. Interventions were processed, and closure scene was performed by original protagonist. POPULATION STUDIED: 15 Workshop participants varied by SES / Race / Ethnicity but all had direct experience with denial of access to health care. Audience (64) varied across categories, but medical students and health care professionals composed >50%. PRINCIPAL FINDINGS: The following perceptions, biases, attitudes and differentiating characteristics emerged: 1) <12% of audience had direct experience with denial of care, 2) audience interventions express judgement that UTMBs Demand & Access Management Program (DAMP) for rationing care poses a problem for medical ethics, 3) health care access disparities compromise the social fabric of communities, 4) strong ameliorative action is necessary to transform the system, 5) none of the proposed interventions gave the scenes satisfying closure. CONCLUSIONS: This Theatre of the Oppressed Forum provided a dynamic structure for dialogue and predisposed audiences toward direct/authentic engagement with real life aspects of a difficult and frustrating issue. Though no clear solutions emerged, the audience demonstrated active empathy for the uninsured, and political will to engage public policy-makers. All participants, including primary care physicians, voiced an urgent need for more detailed understanding of DAMP. Audience members generally agreed that DAMP should be simplified and infused with social justice. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Care consumers and providers need basic information on mechanics of DAMP and similar systems as well as the fiscal parameters behind health care resource allocation. The health care community also needs to engage in further dialogue to develop ethical guidelines for navigating the health care crisis that transcend free market pragmatism, the designation of health care as solely a commodity, and moves the dialogue into the realm of disparities in social justice (eg. John Rawlss difference principle, per audience member suggestion).
Publication Types:
Keywords:
- Catchment Area (Health)
- Continental Population Groups
- Delivery of Health Care
- Demography
- Drama
- Ethnic Groups
- Health Services Accessibility
- Health Services Needs and Demand
- Health Services Research
- Population
- Research
- Social Justice
- education
- ethics
- organization & administration
- hsrmtgs
UI: 103623572
From Meeting Abstracts