CONTEXT AND SIGNIFICANCE
Rates of chronic disease related to the condition of obesity—among them cardiovascular disease, cancer, and type 2 diabetes—do not seem to have responded to fact-based messaging from public health offices. One result is an emergent attention to the integral role of culture in shaping disease and health, both medically and discursively (Fisher et al. 2007); another is the realization that no single discipline has the sufficient scope to encompass all of the factors that underlie complex, real-world problems. Hence transdisciplinary approaches are gaining popularity as a tool for understanding the underlying causes for health disparities in ethnic minority, and/or low-income populations.
However, the disciplines that collaborate together are usually complementary. A recent study of funded collaborations (Holmes et al. 2008) lists over 20 disciplines represented in transdisciplinary health disparities research, none would be considered to represent arts or humanities fields.
Intrigued by the prospects for bringing the arts and humanities to bear on a health problem as complexly socio-cultural as it is medical, in January of 2012 a team of researchers from various disciplines in theatre, humanities, and health sciences at Arizona State University (ASU) commissioned a three-week residency with performing artist and chef Robert Farid Karimi.
The team built a research project around the residency to explore whether a combination of cooking classes and theatre workshops could do for diabetes education and prevention what other programs of health education so far have not—specifically, to lay the groundwork for long-term dietary change—in a measurably significant way. We worked with a community in South Phoenix, home to a diverse population of lower income Latino and African American families, which is arguably a food desert or swamp enucleated within a larger urban candy store of enormous food variety. There, rates of chronic, obesity-related diseases are higher than average in the state and nation (Szkupinski Quiroga & Glick 2012). Karimi conducted three weeks’ worth of cooking and theatre workshops with high school students, ASU college students in allied health areas, and promotoras – community promoters of health from South Phoenix.
Although numerous studies have advocated for a transdisciplinary approach to understanding risk factors for health disparities in ethnic minority and low-income populations, and to designing interventions to mitigate these risks, few have included, much less meaningfully integrated, the disciplines of the humanities and the arts (Halbert et al. 2012). Within the current research group (comprising an anthropologist, a theatre historian, a theatre artist, and 2 health interventionists from nursing), we welcomed the opportunity to expand our knowledge base and to challenge our preconceived notions. We have grown individually and as a team by having to remain open minded while theorizing from a broad, contextually oriented approach that is inclusive of different disciplinary views; we have had to adapt to cognitive shifts in paradigms and be willing to consider all perspectives with open dialogue.
Among our discoveries: first, that the arts can in fact make an “intervention” into health behaviors and attitudes, at least in the short term; positive changes were noted in both categories across all of our participants, although the precise mechanisms by which change occurs requires further study. For that reason, we developed a second NSF-sponsored study, designed to reveal more precisely if there are in fact links between various aspects of theatre-making, and factors identified in the health literature as intermediary to behavioral change.
Using research in drama pedagogies and applied theatre, creativity and play theory, and theatre theory and criticism, we identified several unique aspects of theatre-making --- specifically, authorship, manipulation of multiple symbol systems, rehearsal, ensemble, embodiment, and play — and are assessing their relationship to those factors shown by behavioral sciences to lead to individual change: resonance, self-efficacy, reinforcement, modeling, emotional arousal, agency, and identification. (See figure 1.)
Quantitative measures were administered in English to all participants at both study sites on the first visit and again at the end of the workshops; they included the following:
- The Brief Block FFQ, a 40-item questionnaire that provides estimates of usual and customary dietary intake and screens for fat, fruit and vegetable consumption (Wakimoto et al. 2006).
- The Healthy Lifestyle Behaviors Scale, a 16-item instrument that measures behaviors associated with maintaining a healthy lifestyle on a 5-point Likert scale (Melnyk et al. 2006).
- The Healthy Lifestyle Beliefs Scale, a 16-item instrument that measures beliefs about various facets of maintaining a healthy lifestyle on a 5-point Likert scale, adapted to incorporate items associated with cooking and communication (Melnyk et al. 2006).
- The Perceived Difficulty Scale instrument, a 12-item questionnaire that measures one’s perceived difficulty in living a healthy lifestyle on a 5-point Likert scale (Melnyk 1994).
- The Healthy Eating Beliefs Scale, a 13-item instrument adapted from Armitage and Connor (1999) that measures beliefs specific to healthy eating on a 5-point Likert scale.
- The Self-efficacy Scale is a 5-item questionnaire that measures one’s perceived capability of confronting obstacles to healthy eating (Beech et al, 1999; Luszczynska et al, 2007).
Qualitative Assessment was undertaken between three and five weeks after the final workshop meeting, through interviews with participants individually, in pairs, or in peer groups. The length of the interviews ranged from 45 minutes to an hour and a half. We asked open-ended questions about what they most remembered, what they learned, what they liked and did not like about the workshops, how their learning transferred to other areas of their lives, how they shared their learning with family, friends and community members, the role of theatre and storytelling in their experience, and their suggestions for future workshops.