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Using interactive theatre to help fertility providers better understand sexual and gender minority patients
  1. Lesley A Tarasoff1,2,
  2. Rachel Epstein3,
  3. Datejie C Green4,
  4. Scott Anderson5,
  5. Lori E Ross1,2
  1. 1Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  2. 2Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  3. 3LGBTQ Parenting Network, Sherbourne Health Centre, Toronto, Ontario, Canada
  4. 4CATIE, Toronto, Ontario, Canada
  5. 5Canadian Media Guild, Toronto, Ontario, Canada
  1. Correspondence to Lesley A Tarasoff, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, Ontario, Canada M5T 3M7; esley.tarasoff{at}utoronto.ca

Abstract

Objective To determine the effectiveness of interactive theatre as a knowledge translation and exchange (KTE) method to educate assisted human reproduction (AHR) service providers about lesbian, gay, bisexual, trans and queer (LGBTQ) patients.

Design We transformed data from the ‘Creating Our Families’ study, a qualitative, community-based study of LGBTQ peoples’ experiences accessing AHR services, into a script for an interactive theatre workshop for AHR service providers. Based on forum theatre principles, our workshop included five scenes illustrating LGBTQ people interacting with service providers, followed by audience interventions to these scenes. Before and after the workshop, service providers completed surveys to assess their knowledge and comfort concerning LGBTQ patients, as well as the modality of the interactive theatre workshop as a KTE strategy. Wilcoxon signed-rank tests were used to determine changes in preworkshop and postworkshop knowledge and comfort scores.

Results Thirty AHR service providers attended the workshop. Twenty-three service providers (76.7%) fully completed the preworkshop and postworkshop evaluation forms. Service providers’ knowledge scores significantly improved after the workshop, while their comfort scores minimally decreased. Most agreed that the interactive workshop was an effective KTE method.

Conclusions In comparison with traditional forms of KTE, interactive theatre may be particularly effective in engaging service providers and addressing their attitudes towards marginalised patient populations. Although the evaluation results of our interactive workshop were mostly positive, the long-term impact of the workshop is unknown. Long-term evaluations are needed to determine the effectiveness of arts-based KTE efforts. Other considerations for developing effective arts-based KTE strategies include adequate funding, institutional support, attention to power dynamics and thoughtful collaboration with forum theatre experts.

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Introduction

While some lesbian, gay, bisexual, trans1 and queer (LGBTQ) people have children conceived in different-sex relationships, increasingly LGBTQ people are relying on assisted human reproduction (AHR) services to have genetically related children. Some fertility clinics in large urban centres report that as many as 15–25% of their clients identify as LGBTQ.2 However, many LGBTQ people experience barriers accessing AHR services3–10 as a result of prevailing assumptions that AHR service users are heterosexual and cisgender (non-trans), partnered or married with access to two incomes, and experiencing anatomical infertility.10 ,11 Some or none of these assumptions may be true for LGBTQ people accessing AHR, and thus can cause unnecessary confusion and hardships for LGBTQ people.11

From the ‘Creating Our Families’ study, a qualitative, community-based study of LGBTQ peoples’ experiences accessing AHR services, we deduced there is a pressing need to increase LGBTQ-specific education and training among AHR service providers and for greater LGBTQ visibility in clinic environments.10 Many AHR service providers seem to lack an understanding of LGBTQ people's unique AHR service needs, as well as the diverse sexual orientations, gender identities and family structures common among these service users.10 For instance, although some LGBTQ people do experience fertility problems, many LGBTQ intended parents rely on AHR services solely to access reproductive material (ie, sperm and ova).10–12

For over a decade, community organisations have provided resources and training to healthcare providers in Ontario about the unique service needs of LGBTQ people.13 ,14 However, our recent data suggest that significant service provision barriers persist.10 In addition, we know that traditional knowledge translation and exchange (KTE) methods such as clinical practice guidelines are often underused and thus not particularly effective in changing attitudes, knowledge and quality of care.15–21 As such, we chose the interactive arts-based KTE method, ‘forum theatre’, in an effort to evoke change in AHR service providers’ attitudes and knowledge of LGBTQ people accessing AHR services.

In this paper, we describe the process of developing an interactive theatre workshop based on the ‘Creating Our Families’ study data,10 and provide the evaluation results of the workshop for AHR service providers.

Methods

The objective of the ‘Creating Our Families’ study was to determine whether and how AHR services meet the needs of LGBTQ people, and in turn to identify barriers to and facilitators of AHR service use among LGBTQ people.10 In line with community-based research principles, we collaborated with an advisory committee of LGBTQ parenting educators, AHR service providers and service users throughout the ‘Creating Our Families’ study. Further, all members of the ‘Creating Our Families’ study research team and all those involved in the development and execution of the forum theatre workshop identify as part of the LGBTQ community or communities and some have personal experience accessing AHR services.

Interviews

We conducted 40, 60–90 min, semistructured interviews with 66 LGBTQ people across Ontario, Canada who have used, considered using and/or avoided using AHR services to have genetically related children. These interviews were transcribed verbatim, the data was then organised thematically, and later used to develop a script for the forum theatre workshop and other KTE materials.10–12 ,22

Forum theatre

In forum theatre, spectators are shown a series of scenes that are based on real life situations. In a second run-through of the scenes spectators are invited to participate by stepping in to a role to act out an idea about how to alter what is going on in the scene,23 thereby becoming ‘spect-actors’, breaking down conventional divisions between actors and spectators.24 According to the internationally renowned Brazilian theatre practitioner Augusto Boal who first created this theatrical form, known to many as Theatre of the Oppressed, reducing barriers between the actors and spectators is necessary for social transformation and for the liberation of oppressed or marginalised people.24 Traditionally, spect-actors are from the same oppressed social location as those acting and being portrayed. This establishes “the forum theatre space [a]s a ‘safe’ way for oppressed people to both critically reflect upon, and envision alternatives to the social conditions creating their marginalization” (p. 134).23 In this way, forum theatre challenges the traditional means of theatrical production by offering opportunities for ‘learning by doing’ or to ‘rehearse reality’.23 By design forum theatre is meant to be emotionally provocative and transformative for the actors and the spect-actors.24

The Joker, or facilitator of the play, mediates the actions/reactions between the actors and the spect-actors. It is the joker's responsibility to help all involved to engage productively and safely. The joker facilitates spect-actors who choose to intervene in the scenes, and guides discussion with the spect-actors about the productivity of interventions. The joker's role is explained to the spect-actors from the outset.

Forum theatre offers opportunities to capture the emotional dimension of the phenomena under study that can be difficult to convey with other forms of KTE. In our case this includes patient-service provider interactions and individuals’ experiences of trying to become parents. Dramatising research findings may serve to concretise the data, and the resulting audience engagement may offer greater potential for transforming social understanding than do text-based strategies.25 Research-informed theatre encourages service providers to reflect on the care they provide in order to increase their understanding of patient care issues and enhance communication skills.26–28 In addition, this KTE approach can benefit marginalised service users by providing a forum for telling their stories in a cathartic, therapeutic and politically constructive way.29 ,30 Indeed, forum theatre was originally developed as “a weapon for oppressed people to use toward changing their social reality—theatre for the people, by the people, ‘a rehearsal of revolution’”(p. 14).31

In must be noted however that our use of forum theatre with service provider spect-actors was unorthodox. We allowed the service providers to intervene in the scenes as themselves (or ‘the oppressors’) as opposed to traditional forum theatre, wherein ‘the oppressed’ (or in our case, LGBTQ patients) act as interveners in an attempt to empower themselves in potentially unjust situations. In light of space, we cannot address the implications of this unorthodox use of forum theatre in detail here. In short, beyond some of the logistical challenges we encountered (discussed later), many of the challenges that we encountered were related to power dynamics. As such, we advise researchers to pursue this unorthodox use of forum theatre with caution, paying particular attention to power dynamics (as they relate to professional roles, socioeconomic status, race, gender and other social locations) between service provider spect-actors, researchers, forum theatre practitioners and community members/patients and among the group who develop and perform forum theatre workshops (actors, jokers). Sometimes things do not go as planned in forum theatre. We encourage forum theatre actors and jokers to practice positive and negative or problematic interventions before engaging with spect-actors. Being prepared for what may come will help actors and jokers as well as spect-actors to productively work through interventions that may be considered problematic, such as when a service provider misses the point on a particular issue. Finally, we should note that we are not the first group to engage in forum theatre with service provider spect-actors and that we did do a forum theatre workshop, using the same script described below, with LGBTQ spect-actors. This paper only focuses on the results of the workshop with AHR service providers.

Script development

A person trained in forum theatre and psychotherapy (JB) was hired to collaborate with the research team to develop a script for the play. One member of the research team who conducted many of the interviews (DCG) provided the scriptwriter with excerpts from the transcripts, direction on analysis, interpretation and representation, and had an ongoing dialogue as the script was being written. An advisory committee member of the ‘Creating Our Families’ study (CV) experienced with the topics and communities involved and with developing and directing forum theatre, also assisted with script development. Once the first draft was complete, the research team suggested further revisions. The script was ultimately finalised during rehearsals.

The final script included five scenes, a prologue and an epilogue. Each scene was an amalgam of multiple interviews. As is common in forum theatre,23 ,24 the scenes highlighted worst-case scenarios, which provided ample opportunity for constructive intervention. This was explained to the service provider spect-actors.

Four members of the ‘Creating Our Families’ study research team (RE, DCG, SA, LER) and one advisory committee member (CV) performed the final script. A total of 20 characters were played, representing a variety of gender identities, sexual orientations, relationship structures, and roles, including the joker, four physicians, a nurse, a counsellor, intended parents and a known sperm donor. The scenes addressed multiple issues and scenarios including: the need to access reproductive material but not fertility tests or treatments, having a known sperm donor, the emotional burden of having to lie about one's identity and relationships in order to receive care, pronoun use, the cost of treatment, homophobia and related discrimination and stigma (eg, HIV stigma), and contradictory practices within the AHR system (see refs. 2 and 12 for further discussion of the final issue).

The performance of the full play before interventions ran about 45 min. Following the play, the joker (RE) asked the audience which scenes stood out most for them and then service provider spect-actors volunteered to run through interventions of these scenes. The workshop lasted 90 min in total.

Invitations and accreditation

We mailed invitations for the workshop to all fertility clinics in the Greater Toronto Area at least 1 month before the workshop, and followed up with a mail and email reminder 2 weeks before the workshop. Members of the ‘Creating Our Families’ study advisory committee were also invited via email and telephone. The workshop was also advertised on a number of relevant Listservs, webpages (eg, the LGBTQ Parenting Network webpage) and via social media (eg, Facebook).

As a strategy to encourage AHR service providers to attend the workshop, we had the workshop accredited by the Canadian Fertility and Andrology Society. With accreditation, the workshop met the standards of the Royal College of Physicians and Surgeons of Canada's Continuing Professional Development Program; physicians who attended the workshop were eligible for Continuing Medical Education credit.

Workshop results analysis

Data analysis was conducted using SPSS V.15.0. Descriptive analyses were completed to determine participant demographics as well as workshop objective, modality and practice integration scores. To determine if there was a change in participants’ knowledge and comfort scores from before the workshop to after the workshop, we performed the Wilcoxon signed-rank test.

Results

A total of 30 AHR service providers attended the workshop. Of those 28 (93.3%) completed the preworkshop evaluation form and only 23 (76.6%) of the 28 completed the postworkshop evaluation forms. The pre-evaluation forms included sociodemographic items, and questions about comfort and knowledge of working with LGBTQ people was scored on a Likert-type scale (where 1=strongly disagree to 7=strongly agree; eg, “I feel knowledgeable about providing AHR service to lesbian clients/patients”). The postevaluation forms included the same comfort and knowledge items, as well as questions concerning the objectives and modality of the workshop (eg, “Helped me to better understand how to work with LGBTQ clients”). Participants also had the opportunity to provide qualitative feedback about the effectiveness of the workshop and what they had learned from the workshop.

Participant demographics

The majority of the service providers who completed evaluation forms identified as heterosexual (23/28 (82.1%)) and women (22/27 (81.5%)). A wide range of professional disciplines were represented among the service provider spect-actors, including obstetrics, reproductive endocrinology, social work and administration (table 1).

Table 1

Workshop participant demographics

Despite the fact that we had our workshop accredited by the Canadian Fertility and Andrology Society, only two physicians attended the workshop—both of whom were male, though only one completed the evaluation forms. Unfortunately, we only asked service providers to indicate their professional discipline(s) on the evaluation forms and therefore cannot describe what role each plays in their service/clinic. However, based on our prior experience working with fertility clinics, we know that fertility counsellors, clinic managers and nurses made up at least half of the service provider spect-actors at our workshop. Some service providers however did indicate their professional roles on the evaluation forms. For instance, one service provider identified as a lawyer, one as a midwife, and one as a sonographer.

Preworkshop evaluation

Overall, service provider spect-actors reported considerably high levels of comfort and knowledge working with LGBTQ patients prior to the workshop, with knowledge scores lowest regarding trans patients (tables 2 and 3).

Table 2

Workshop participant comfort scores, presession and postsession

Table 3

Workshop participant knowledge scores, presession and postsession

Postworkshop evaluation

Changes in knowledge and comfort scores

We found that there was a statistically significant improvement in knowledge scores among participants pertaining to lesbian (Z=−2.138, p<0.05), bisexual (Z=−2.326, p<0.05) and trans patients (Z=−2.199, p<0.05) immediately following the workshop. Interestingly, rather than an increase in comfort, on average, service provider spect-actors reported a minimal (though not statistically significant) decrease in comfort working with lesbian, gay and bisexual patients after the workshop. The qualitative data (below) somewhat speak to this discrepancy. With regards to trans patients, participants indicated a slight increase in comfort working with these patients (Z=−1.725, p=0.084) (tables 2 and 3).

Male service providers and some of who indicated their professional discipline as managerial and/or administrative generally indicated lower than average knowledge and comfort scores preworkshop and postworkshop. For instance, a man in a managerial position indicated a preworkshop score of 5 (agree) regarding knowledge about providing services to trans patients and a postworkshop score of 2 (somewhat disagree). Not surprisingly, those who identified as lesbian, gay, bisexual, queer, or sexual minority (LGBQ) reported higher preworkshop and postworkshop scores than those who identified as heterosexual. Most of the LGBQ-identified service provider spect-actors however did not seem to hold positions of power within fertility clinics and/or are not affiliated with a clinic (ie, few of sexual minority spect-actors reported their professional discipline(s) as gynaecology, reproductive endocrinology, andrology or managerial). Given the small sample size however, no real inferences can be made regarding the knowledge and comfort levels of service providers based on their gender, sexual orientation or professional discipline(s).

Strengths of workshop

Service provider spect-actors generally agreed that the workshop helped them to understand the results of the ‘Creating Our Families’ study (24/26 (92.3%)). From the workshop, most felt that they had learned to identify institutional or organisational barriers to accessing AHR services for LGBTQ people (24/27 (88.9%)), as well as learned about strategies for providing appropriate AHR care to LGBTQ people (23/27 (85.2%)). For service provider participants, the workshop significantly helped them understand the barriers that LGBTQ people encounter accessing AHR services (24/27 (88.9%)). They felt that the interactive workshop helped them to better understand how to work with LGBTQ clients (25/27 (92.6%)), and generally agreed that the workshop experience had changed their understanding of sexual and gender minority people (24/27 (88.9%)). Finally, most agreed that their practice will change based on the workshop (19/23 (82.6%)). Note that for ease of reporting, scores are presented here as aggregate scores (Strongly Agree, Somewhat Agree and Agree=Agree).

Qualitative feedback

The workshop was well-received. Service provider spect-actors found it engaging, humorous, ‘positive’, and ‘realistic’ (“this workshop was well done and presented realistic scenarios with issues that LGBTQ people face”). Our findings suggest that forum theatre is an effective means to capture the emotional dimension of the phenomena under study (“[It is] eas[y] to understand/sympathize with difficulties when seeing them portrayed by people”). Many commented that the interactive nature of the workshop was effective (“creative way to shed light to an important issue”; “message was brought home in a visceral visual and memorable way.”), though some felt that we should have allotted more time for interventions and discussion (“too short—need[ed] more time and ability to discuss more situations”). Some commented that the solutions offered were not specific enough in terms of how service providers might improve their practices (“we'd like more direction; it was very open which is great but in some cases it would be better to have specific direction in how to deal w[ith] situations”). As such, many expressed a desire to have the workshop brought ‘into the[ir] clinic.’ Notably, many commented that the workshop encouraged them to rethink previously held assumptions about LGBTQ people and their AHR service needs. Related to this, many recognised the need to modify all existing clinic forms and documentation to be more inclusive of LGBTQ identities and family configurations (“The changes that can be made at the health care levels to improve patient welfare are small but have a big impact”).

Postworkshop follow-up

In the days after the workshop, a number of service provider spect-actors contacted us to ask if we could present our workshop at their fertility clinics. Another provider even dedicated a blog post to us, writing that our workshop was “the hands-down best presentation regarding ARTs [assisted reproductive technologies] that I have been to all year…”32 This service provider reflected: I have to admit, I had my doubts about a performance-based workshop, but it was incredibly effective. As far as we have come with people of the LGBTQ community having access to ARTs, the experiences as performed in the workshop were shocking, eye-opening and traumatic. From the things that we can easily remedy to be more sensitive, such as offering genderless bathrooms, to the way consent forms are drafted making assumptions as to gender and sexuality, this presentation highlighted practical ways in which we can make ART services truly accessible to the LGBTQ community.32

Discussion

Overall, the forum theatre workshop had a positive effect on AHR service providers, similar to the outcomes of other health research-informed theatrical productions.33 ,34 Although AHR service providers reported slightly lower levels of comfort working with sexual minority patients after the workshop, most reported an increase in knowledge. These finding suggest that providers are not as knowledgeable about LGBTQ patients’ identities and AHR service needs as initially projected. Said differently, a decline in comfort scores can be interpreted as a sign of increased humility in the face of a community that may be more complex and diverse than AHR service providers realised. The decline in comfort working with sexual minority patients reported by service provider spect-actors postworkshop can be interpreted as a positive outcome of forum theatre. Feelings of discomfort or uncertainty may evoke self-reflection and motivation to learn and improve practice.

Regarding the slight increase in comfort working with trans patients, it is fair to suggest that this may be correlated with the increase in knowledge reported. Said differently, increased exposure to trans people's AHR service experiences via the workshop resulted in increased knowledge of trans people's AHR service experiences and subsequently increased comfort in working with trans patients. These results point to the transformative power of forum theatre; by drawing on and actively engaging in the lived experiences and needs of ‘the oppressed,’ forum theatre evokes humility and learning in a way that traditional forms of KTE activities often do not.

Our evaluation results suggest that increased exposure to LGBTQ health issues increases knowledge levels. This finding is consistent with other studies; for instance, residents and medical students in two studies concerning the integration of LGBTQ content into curricula reported feeling more knowledgeable of LGBTQ issues and more prepared and willing to care for LGBTQ patients after the introduction of this curriculum.35 ,36 Despite these advances, unfortunately, there is still limited LGBTQ content in medical school curricula.37 ,38

In sum, the results of our workshop confirm that, “through theatre, reason and compassion can combine to provide audience members with understandings of research findings” (p. 86).39

Given its promise as ‘a weapon of liberation’ (p. ix),24 health services researchers and educators are increasingly turning to theatrical performances as an innovative and accessible approach to generate data and disseminate research findings and recommendations.29 ,40 Research-informed productions have been developed for the purpose of disseminating research findings to healthcare providers, students, patients and the general public on the topics of mental illness,34 ,41 substance use,42 breast cancer,43 ovarian cancer,44 end of life care,45 ,46 traumatic brain injury47 ,48 and Alzheimer's disease,49–51 among others.29 Indeed, of the 71 studies reviewed by Boydell et al, after photo-based methods (n=23), theatre was the most common arts-based KTE method used by health researchers (n=21).40 However, to our knowledge, we are the first group to use forum theatre to engage AHR service providers, particularly pertaining to the LGBTQ patient population.

Many service provider spect-actors commented on their intentions to change their clinic's forms to better reflect LGBTQ identities, to make their clinics appear more LGBTQ-positive, and to actively include non-birth partners/parents in the AHR process. Short-term evaluations suggest that our interactive performance was effective in altering AHR service providers’ views of LGBTQ patients in ways that may be associated with improvements in the quality of care delivered. The long-term impact of our workshop on service providers’ practices however is unknown. If anything, “even if these [interactive workshops] do not lead directly to change, they make the participants aware of their own potential to find other ways of living and being” (p. 211).52

Limitations and future considerations

Our findings on the efficacy of this KTE effort are limited, largely due to the fact that we only collected evaluation data immediately after the workshop. We do not know the long-term impact or implications of the workshop on AHR service providers’ views and practices. More attention is needed on the evaluation of arts-based KTE approaches23 ,53 and continuing educational interventions more broadly.54

It may be advisable to include many demographic items on arts-based KTE activity evaluations. For instance, in addition to gender, participants’ age and time since graduation may be particularly relevant when considering LGBTQ patients, as there is some research to suggest that younger, female service providers hold more positive attitudes towards LGBTQ patients.55 ,56

Our study and thus results are limited due to the small sample size and because we did not ask service providers to indicate their role(s) and consequently the level of power or decision-making authority they hold in their clinics. In addition to the demographic items listed above, including professional role on future evaluation forms is vital.

We can only speculate as to why so few service providers attended our workshop. With regard to physicians in particular we know that it is difficult to get physicians to participate in research and research-related activities for a variety of reasons, such as lack of time and lack of interest in research. Moreover, in Ontario (and much of Canada) where AHR services are predominately private services there is arguably little incentive for AHR service providers to spend time away from the clinic to do non-paid activities. As a way to remedy this, we did provide food and schedule our workshop in the afternoon when clinics are typically less busy. If we had more resources, we may have been able to do our workshop at a number of individual clinics. Instead, to get ‘more bang for our buck’ and in an effort to create a comfortable environment for all involved, we decided to hold our workshop at a community centre. Further, given the private nature of AHR services in Ontario, we did not want to seem as though we were favouring one clinic over another or create tensions among providers from different clinics by holding the workshop at a specific clinic.

All that said, those service providers who did attend our workshop arguably shared what they learned at the workshop with physicians and other service providers at their respective clinics. As such, physicians might still be influenced by those who attended the workshop. Of note is the fact that a number of service providers in managerial positions, with presumably decision-making power and power to set the tone in clinic settings, attended the workshop. Our workshop was most relevant to those service providers who make decisions about access to fertility services (eg, counsellors and physicians) and those who have the power to shape clinic culture and whether it is welcoming to LGBTQ patients (eg, administration and management), rather than to those working ‘behind the scenes’ (eg, lab technicians). The fact that a fair number of counsellors and those in managerial roles attended the workshop is promising.

Another major limitation or challenge for us was a lack of resources for our forum theatre production. We had somewhat miscalculated the resources required to develop and execute an interactive theatre workshop, particularly with regards to time and emotional energy. With this knowledge, we suggest that the temporal, financial and emotional cost of research-informed performances not be underestimated. Funding agencies should attend to this reality; there should be more institutional support for arts-based KTE initiatives. In some cases, supportive counselling may be valuable if the cast, crew or spect-actors find the performance emotionally challenging.

Moreover, adequate financial resources are needed to permit the proper collaboration of researchers with forum theatre practitioners. Without the expertise of professional forum theatre practitioners, there is the risk of creating a performance that misses the revolutionary goals of forum theatre, further marginalising already vulnerable patient populations.

In an effort to address some of the challenges we encountered developing and performing our forum theatre workshop, and because we do not have a theatre troupe readily available, we have decided to create a video based on the workshop script to be used in individual clinics, classroom settings and by LGBTQ communities. The video will be accompanied by materials related to the ‘Creating Our Families’ study and be available for free online.

Conclusion

The passive dissemination of clinical practice guidelines and other traditional forms of KTE may not be particularly effective in changing practice behaviour.18 ,19 ,57–59 Keeley, for instance, writes that, “key features of guidelines that make them likely to change clinician behaviour are that they should take account of local circumstances, be disseminated by active educational interventions and use patient-specific reminders…” (p. 372, emphasis added).60 As such, we concur with Feder et al that, guidelines “should be seen as only one strategy that can help improve the quality of care that patients receive”(p. 730).61 Arts-based KTE activities are an effective option for medical educators to consider in their aim to improve the quality of care because “[a]n arts-based component may contribute to self-awareness and self-presentation, support the establishing of successful doctor-patient relationships and invoke respect and compliance” (p. 437).62

Based on the results of our workshop, we believe that interactive theatre is an effective KTE method for health services research and a powerful way to engage and potentially alter the hearts and minds of AHR service providers working with LGBTQ people. Such a transformation on the part of AHR service providers is crucial in the name of human rights; indeed, the American Society for Reproductive Medicine63 argues that (like Canadian legislation64) the denial of fertility services on the basis of marital status or sexual orientation is unjustified. Using arts-based KTE methods may be particularly advantageous when it comes to sharing the results of research on marginalised patient populations and in turn may contribute to improving the quality of care for these populations.

Acknowledgments

The authors thank Jessica Bleuer and Chris Veldhoven for their invaluable contributions to this project (script writing, directing and acting). For more information about this project, visit http://www.lgbtqhealth.ca/projects/usingtheatre.php. The authors also acknowledge three anonymous reviewers for their insightful comments on an earlier draft of this paper.

References

Footnotes

  • Contributors LAT contributed to the study conception and design, led data collection and analysis/interpretation, led manuscript writing, and administratively coordinated the submission of the manuscript. She also served as the coordinator and stage manager of the workshop. RE made substantial contributions to the study conception and design, and acted as the joker for the forum theatre workshop. RE was a co-investigator of the study. DCG contributed to the study conception and design, script writing, and was a player in the forum theatre workshop. SA made substantial contributions to the study conception and design, and was a player in the forum theatre workshop. LER, the principal investigator of the study, made substantial contributions to the study conception and design, assisted with data analysis, and served as supervising author. All authors contributed to the critical revision of the article and approved the final manuscript for publication.

  • Funding This project was funded by the Canadian Institutes of Health Research (Meetings, Planning and Dissemination Grant: Dissemination Events, 201102 Competition).

  • Competing interests None.

  • Ethics approval This project was approved by the Research Ethics Board at the Centre for Addiction and Mental Health.

  • Provenance and peer review Not commissioned; externally peer reviewed.