“Like Russian dolls”: Using co-developed, creative approaches to disseminate research on sensitive subjects

Cat Papastavrou Brooks is a PhD researcher at the University of Bristol looking at the impact of neighbourhood violence. Most of her research centres around trauma, co-production methodology and the use of creative approaches in health treatment and research. She was pivotal in producing a new How-To Guide (PDF) for co-developed theatre as a format for disseminating research on sensitive subjects. Here she blogs about how the guide came about.

The Hard Evidence project emerged from the relationships built during the coMforT (Mindfulness for Trauma) study, led by Natalia Lewis and funded by the NIHR Bristol Biomedical Research Centre (BRC) and the Centre for Academic Primary Care at the University of Bristol. coMforT developed and pilot tested a mindfulness course for women with post-traumatic stress and a history of domestic abuse. It was supported by an advisory group of six women survivors of domestic abuse.

After the study ended, the team wanted to explore new ways to continue their partnership. I totally understand this desire to continue a project when a study with brilliant public contributors ends. They got funding to create a play in collaboration with Ingrid Jones from acta Community Theatre in Bristol.

The resulting play Hard Evidence offered a more accessible and impactful form of dissemination. It was about a domestic abuse survivor who, through involvement in research, became better equipped to support a friend experiencing abuse.

I wasn’t involved in the coMforT study or the play. I was working as a researcher on a large domestic abuse study at the University of Bristol, which was coming to an end at the time. I’d seen the performances advertised and was interested, but I wasn’t living in Bristol then.

I’d promised my PhD supervisors that, once the project I was working on ended, I’d focus on my PhD and not take on any other work.

But several people (including my line manager on the domestic abuse project) forwarded me a call for a researcher to evaluate Hard Evidence. How could I resist a project that touched on so many things I care about?

First, its use of creative and innovative approaches in co-production and public involvement. I’ve found much of what’s called ‘public involvement’ involves simply bringing public contributors onto research teams and expecting them to adapt to an alien—and often hostile—culture. This project was completely different. It brought both researchers and public contributors into a radically different and playful space—the theatre—helping to level power imbalances and enabling new forms of collaboration.

Second, the way it made research accessible to people. One of the most disheartening aspects of research is the time we spend writing papers that only a handful of academics will ever read (not even my family reads mine!). This project brought research to the public in a format that was both interesting and emotionally engaging.

Third, the question of how to be truly “trauma-informed.” This is a big topic in mental health services. Too often, “trauma-informed” is interpreted as “ask people about their trauma”—which is the exact opposite of what it should mean. I was curious to see how a play dealing with such a sensitive and potentially traumatising subject had been developed to avoid causing harm—to either the audience or those involved in creating it.

Much to the dismay and eventual resignation of my PhD supervisors, I joined the project in 2022. The team had received funding from the Bristol BRC to evaluate the play, and to stage two ‘on tour’ performances at community centres in Bristol.

The Hard Evidence team included Natalia Lewis (lead researcher on the coMforT study), Noreen Hopewell-Kelly (who oversaw public involvement), Shass Blake and Alison Prince (public contributors on the study who went on to co-develop and act in the play), Ingrid Jones from acta (theatre director), and Zoe Trinder-Widdess and Rosa Martyn (comms leads from Bristol BRC and acta, respectively). From our first meeting, it was clear how close-knit the team was—there was a lot of laughter alongside open and honest reflection.

Together, we  defined the evaluation aims: to explore the play’s engagement with audiences, as well as potential risks or harms. I interviewed the project team and audience members (15 interviews in total) and analysed audience questionnaires.

The play seemed especially effective in communicating messages around domestic abuse—more so than the more nuanced theme of the value of public involvement. It achieved this impact by emotionally engaging audiences. The most affected audiences were those with their own experience of domestic abuse. Interviewees felt that the value of the play lay in its depth, rather than its breadth, of dissemination. We also identified serious risks of re-traumatisation for both audience members and actors. We collected suggestions for how to minimise or mitigate these risks. Read our full evaluation.

In keeping with the spirit of the project, we didn’t want to stop with an academic paper. We wanted to co-develop something practical and useful. This is where it starts to feel a bit like Russian dolls: the How-To Guide is a creative dissemination output (an illustrated booklet) from a research project evaluating another creative dissemination output (the Hard Evidence play), which came out of a study (the coMforT study). Confused yet?

We held a co-production event – part workshop, part celebration – with theatre members, public contributors, researchers, PPI specialists and people with lived experience of domestic abuse. We shared our findings and invited participants to draw on our work and their experiences to develop strategies for creative dissemination on sensitive subjects that protect both audiences and project teams. It was incredible to have so many people from different backgrounds in one room, sharing ideas, and especially moving to reflect on how powerful the play had been for survivors of domestic abuse.

The event was live-illustrated by artist Camille Aubry, and we took notes. These developed into the How-To Guide, which we sent to workshop attendees and the Hard Evidence team for comments and revisions.

Shirine Watts designed the guide, and Camille illustrated it. It includes advice on things to consider before you start, safety, trust, collaboration and peer support, choice and empowerment and accessibility.

This has been one of the most interesting and innovative research projects I’ve been part of, with the best team of people behind it—and I’m so excited to share the How-To Guide with everyone. I hope it inspires other researchers, theatre-makers and people with lived experience to consider this approach.