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Dr Gioia Mosler is Head of Global Health Group and Community Engagement at the Blizard Institute, Queen Mary University of London. She led a project called In Control, funded by the Health Foundation’s Evidence into Practice programme, which introduced a theatre and workshop programme in schools to build awareness and understanding around asthma. We spoke to her about how this approach helped them translate research findings into behaviour change.

Why was the In Control project needed?

Research we did with young pupils with asthma in London secondary schools found that almost half of them had poor control of their symptoms. Effective medication for almost all people with asthma is readily available, yet a lack of understanding and poor self management of their condition means that many young people suffer more from their condition than they need to.  

Young people told us that as well as sometimes simply forgetting to take their medication, they were also affected by the behaviour of their peers at school. Worries about being teased made some of them reluctant to use their inhaler in public. They felt that both teachers and other pupils didn’t really know much about their condition or understand why they needed an inhaler. 

We really wanted to address these social issues, but traditional academic routes or health care services do not easily provide the opportunity to do so. We needed to find a way of translating our research into something actionable. And that’s how the In Control project came about. 

What did you do?

We collaborated with Tramshed (previously Greenwich & Lewisham Young People’s Theatre) to develop, tour and evaluate a theatre and workshop programme about asthma. It aimed to empower and support children with asthma, helping them to feel confident about self managing their condition. You can watch a great documentary about the project.

In Control toured nine secondary schools in London during 2017, performing in front of 1,900 children aged 11 to 13 years. A further 10 schools were visited during 2018 using additional funding.

Our evaluation showed that 99% of the audience enjoyed In Control and 85% said the performance changed how they think or feel about asthma. 

Why did you pick theatre as a format for turning your evidence into practice? 

Theatre can provide a particularly immersive experience, which helps the audience develop understanding and empathy. We wanted young people to engage with how it feels to have asthma. 

The performance is based on the Theatre of the oppressed, a form of popular community-based education that uses theatre as a tool for social change. Students watch the play (about a girl with asthma and her two classmates), and then participate in a workshop. The critical thing is that the main actress stays in role and interacts with the audience during the workshop discussion. That keeps everyone a bit on edge, and really involved. 

How were young people involved in developing the performance?

As well as being involved in our initial research, young people with asthma attended focus groups and interviews to help us develop the performance. This really helped us to create a realistic world in the play, reflecting how young people live and the language they use. And we got lots of comments from young people after seeing the performance that they felt it was authentic, which was great. That wouldn’t have been possible without having young people so involved. 

Why is it important for researchers and policymakers to step outside clinical settings when thinking about how to act on the evidence?

Embedding evidence is often about getting people to act or think differently. But just telling people how to improve their health isn’t always enough to change behaviour. And it's very hard when you’re working within a traditional health care setting to do more than just inform. Stepping outside of that health care setting allows space for much more creative approaches – like working with the media, telling stories through theatre and film, or even using computer games. These opportunities are underused at the moment.

Working with a creative team nudges scientists to move away from their normal ways of thinking, but it’s important that the science is not lost – approaches still need to be developed with enough scientific rigour. That’s why you need input from lots of different people. For us it was really important to have a psychologist involved, as well as medical professionals to look over the detail, experts in theatre to create something effective and entertaining around health, and young people themselves to ensure it rang true. 

What next? 

Since the Health Foundation award, funding has been secured from Barts Charity to run the performance alongside educational workshops in a trial. We are currently in the middle of running this randomised control trial, which looks at attitude changes and how they chart over time at 3, 6 and 12 month follow-up. The In Control project has also influenced work we’re now doing with young people with asthma across six African countries, called ACACIA, where we plan to roll out a similar theatre intervention. 

Apply for our Evidence in Practice programme

The latest round of our Evidence into Practice programme is now open for application until 31 October 2019. The programme is designed to help research teams bridge the gap from academic research findings, to actionable information for people practising in the field. Find out more.

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.

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