Changing the Face of Health Care: A Participatory Theater Intervention for Promoting Retention of Under-Represented Minority Students in Health Care

PURPOSE: Health workforce diversity and under-represented minority student enrollment in health professions programs are major sources of concern for policy makers, employers, and allied health professions (Williams et al., 2014). The American Occupational Therapy Association’s vision 2025 states ‘equity, inclusion, and diversity is a critical pillar of our vision for the future, leading to an inclusive profession,’ but educational, economic, and socio-cultural barriers limit under-represented minority students in successful enrollment in and graduation from health professions programs (Garriott et al., 2015). As our nation grapples with reducing racial/ethnic health disparities and reforming the US health care system, we must take proactive steps to ensure a diverse, culturally competent healthcare workforce (Betancourt et al., 2016). With this purpose in mind, we piloted a 6-week theatre intervention protocol (TIP) aiming to engage and retain minority students seeking degrees in healthcare professions. Such work is a critical aspect of supporting occupational justice in the area of education. Our research questions were: Q1) does completion of TIP improve healthcare students’ occupational engagement? and Q2) what are the potential mechanisms of change impacting students’ engagement and participation in their journeys?

METHOD: TIP was delivered via a 1-credit, 8-week course, advertised to minority healthcare students with flyers and by their advisors. We used exploratory sequential mixed methods. During week 1, the Principal Investigator (PI) and two professional playwrights/directors collected qualitative data from students via a focus group, which led to script development based on themes of feeling lost, family pressure, internal pressure, encountering obstacles, struggle and adversity, and envisioned goals. The PI then conducted baseline interviews using the Occupational Circumstances Assessment Interview and Rating Scale—a 12-item measure of occupational participation and engagement (OCAIRS; Forsyth et al. 2006). Students met with directors twice a week for 6 weeks to rehearse the play, which was performed in a public, professional theatre and followed by a talk-back with the audience. The PI conducted follow-up OCAIRS during week 8 of the course. Total scores were assessed using paired t-tests and individual item scores were compared to examine trends in data.

RESULTS: Data met the assumptions for t-test. Paired t-tests indicated significant improvement in total OCAIRS score (3.86 points, p < 0.01, d = 1.3) and ‘habits’ sub-scale score (.86 points, p < 0.05, d = .95) with large effect sizes for both, although these may be slightly inflated due to small sample (n = 7).

CONCLUSIONS: TIP participants demonstrated an overall increase in occupational engagement (Q1). While many factors likely contributed to this, findings suggest TIP’s mechanism of change may lie within its effect on students’ habits (Q2). This follows from the nature of the intervention, which requires significant commitment toward the new occupation of expressing one’s journey through theatrical performance. This proposal is important to practice, policy, and science because it highlights a role for occupational therapists in promoting the occupational justice of minority healthcare students and could help establish a more diverse healthcare force that, in effect, fosters equitable services for diverse populations. Future study and implementation efforts could also contribute to the diversification of the field of occupational therapy, bringing a range of essential perspectives into the profession. Implementation of this work demonstrates a commitment from the profession to supporting minority students and equitable access to education and work.

References

Williams, S. D., Hansen, K., Smithey, M., Burnley, J., Koplitz, M., Koyama, K., ... & Bakos, A. (2014). Using social determinants of health to link health workforce diversity, care quality and access, and health disparities to achieve health equity in nursing. Public Health Reports, 129(1_suppl2), 32-36.

Betancourt, J. R., Green, A. R., Carrillo, J. E., & Owusu Ananeh-Firempong, I. I. (2016). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports.

Forsyth, K., Deshpande, S., Kielhofner, G., Henriksson, C., Haglund, L., Olson, L., ... & Kulkarni, S. (2006). A user’s manual for the Occupational Circumstances Assessment Interview and Rating Scale (OCAIRS). Model of Human Occupation Clearinghouse, Department of Occupational Therapy, College of Applied Health Sciences, University of Illinois at Chicago.

Creswell, J. W., & Tashakkori, A. (2007). Developing publishable mixed methods manuscripts. Journal of Mixed Methods Research, 1(2), 107–111. http://dx.doi.org/10.1177/1558689806298644