Drama: A tool for diabetes education
by Susan Taylor, PDt, CDE
Diabetes educators are in the business of helping people with diabetes and their families manage a chronic condition that can be upsetting and confusing. We are continually searching for ways to do our jobs better. One common way to educate has been information dissemination using pamphlets and lecture (1). The recipients of this information are then expected to synthesize the information and apply it to their daily lives. Increasingly, adult educators are becoming aware that the didactic method of education is overused and not always effective (2,3). Consequently, the alternative approaches to education and counseling are being used (4). One alternative approach that we are using in our work as diabetes educators is educational theatre. We have developed a series of skits that can be used in diabetes education.
In 1994, we received the Bayer Award for Educational Product Development. Our goal was to develop a series of dramatic sketches that could be used in diabetes education. We called the project Drama: A device for diabetes education.
The project was born out of a desire by my colleague, Lois MacDonald, RN, and myself to improve our diabetes education program. We hoped that by adding a bit of theatre to our program we would make the diabetes education process more interesting and enjoyable for both client and staff. We wanted to do something to make diabetes education more meaningful and relevant to our clients. Client's body language and failure to attend second and third classes indicated a possible boredom with an array of facts and figures on diabetes through lectures. Anecdotes from others used words such as long, dull, boring. It was apparent we were not alone.
One criteria for receiving the Bayer Award is that the educational product must be designed to benefit people across Canada. We had to educate other diabetes educators, hopefully influencing them to try using drama in their work. To this end, we presented some of the sketches at a national diabetes conference in Toronto, 1995 and at a provincial conference in Halifax, 1996. By extensions, this article intends to encourage diabetes educators to consider use of educational theatre in their work.
Getting started
We began using drama on an experimental basis. We tried replacing a usual lecture on the subject of diabetes and alcohol with a short (5 minute) skit. The skit described a woman with Type 1 diabetes who got out of control at a party. We felt apprehensive, even ridiculous and self conscious, the first time we used the method. We wore costumes and wigs which added to the drama and humor, but this also added to our feelings of self consciousness. Fortunately, any concerns dissipated because of the positive response we got from the clients during and following the skit.
Clients paid attention, asked questions and participated freely in discussion following the dramatization. They laughed and relaxed. Indeed, the atmosphere of the room changed for the better. Gone was the tense, reserved feeling that can exist in health care institutions. Clients reported that they wanted more skits as this method of teaching them really helped them to learn. The experience led to more skits and eventually a booklet for use by other educators. The booklet, Therapeutic Theatre: Short skits for diabetes education, contains fifteen skits.
The lecture vs. storytelling
Diabetes educators, among others, tend to overuse the lecture style of teaching (4). Research finds that this didactic approach is as good as any for disseminating information but its overuse is not justified (5). Likely we rely on the lecture because we are most familiar with this method. There are other ways to teach: ways that may be more effective in many instances.
Storytelling is believed to be one of the oldest and most effective ways to teach (6). Aesop's fables, Greek mythology, biblical stories and native legends are examples of how storytelling has been used throughout the ages in many societies and cultures. It seems entertainment is more powerful than preaching (7).
The experience of presenting our work in Toronto, 1995, led me to survey diabetes educators at the 1996 Diabetes Care Program of Nova Scotia provincial conference. The survey showed that 98.5% of diabetes educators responding did not use drama in their work. Although much interest was generated following the national and provincial presentations, there were also identified barriers to using drama as an educational tool:
That diabetes educators seldom use drama and feel untrained to use the approach is not surprising given our medical based training and desire to be perceived as knowledgeable and serious professionals. Many of the skits are humorous and therefore can be seen as vehicles not only for storytelling but for humor application as well. Draheim comments that health professionals hold many misconceptions concerning humor application (8):
For those educators who have self conscious feelings or lack confidence in their ability to effectively use drama, we suggest starting simple by reading the skits out loud. You can improve your reading by adding enthusiasm, character and tone to your voice. The process is similar to reading a story to a child. Positive feedback from clients will encourage you to add actions, ad libbing, etc. Reading the skits may be all you do, depending upon your comfort level and circumstance - still a positive and effective device for teaching.
Educational theatre, literacy, and adult education
The literature on adult education suggests we use a variety of teaching techniques to meet the various learning styles of clients. The material should be relevant to people's experiences and needs (2,9). Drama provides an extra way to help people learn about diabetes. It is also a viable way to address literacy levels and other barriers to learning.
According to statistics Canada, 1990, 22% of Canadians are low skilled readers and 16% are very limited in reading ability or do not read at all. Similarly, Bates points out that this group is alienated by an increasing technological system that places vast amounts of information out of their reach (10). He feels this situation calls for new options for meeting the multiple learning needs of a variety of people. Popular theatre is an educational process that has proven itself useful throughout the developing world; it may also be useful in Canada.
Theatre encompasses a number of adult education principals such as relevance, active participation, collaboration, humor and respect for the learner (4). It creates dialogue and involves both the affective and cognitive domains of learning (11).
Occasionally our clients act in the skits with us. This works very well. We announce that an actor is needed for the next class, asking for a volunteer. The result is group cohesiveness and a strong desire by the group to return to class to see the skit. Another technique we use to encourage active participation in the learning process and problem solving is to freeze the action. The audience tell the 'actors' what to do. This technique, used with a skit on hypoglycemia, draws the audience into the action and problem solving when an actor 'goes into a reaction'.
Breaking down barriers to communication/medical jargon
Vella feels adult learning is best achieved in dialogue or two way communication (12). She believes that a significant problem in adult education is the perceived distance between teacher and student, between doctor and patient, between lawyer and client, etc. Until the distance is bridged, the dialogue lags. Martin Shapiro believes the culture of Western health care environment is authoritarianism (13). The person with authority commands respect and expects obedience from those with less authority (patient, client, technician, etc.). We perpetuate alienation in the medical system by overusing medical jargon with people.
Drama helps us break away from medical jargon. It can lead to effective two way communication or dialogue. Educational skits use everyday language. By participating, we remove our shield of 'professionalism' and authority. Clients may see us as their friends.
Personal education philosophy
The decision and practice of using drama and humor in diabetes education comes down what one's personal education philosophy is. This philosophy is a collection of beliefs regarding the purpose and process of teaching (14). The collection of beliefs changes as educators develop, learn, and grow. It is suggested that we take inventory of our own beliefs about education to ensure that our practice is congruent with our philosophy.
Flannery believes that all of us has a personal education philosophy though we may not be aware of it. If you believe that drama and humor will discredit your professionalism or that it is inappropriate for diabetes education then your practice should reflect that. However, if you believe literacy and authoritarianism are barriers to learning about diabetes, and that drama and humor might breakdown barriers to learning, you may consider using theatre for education. You may believe humor, drama, and storytelling are excellent ways to teach about diabetes but you may be relying solely on the lecture method. Thus, the personal philosophy does not match practice or behavior.
As stated earlier, the first time we tried drama we felt self conscious until we discovered that people responded positively. We are not always up for play-acting, but we do it anyway because we believe drama enhances learning and helps improve our program. Our practice reflects our belief and personal philosophy about education. Literature on adult education encourages us to examine our working educational philosophy in order to make informed choices about how we teach and to evaluate our work. It is an ongoing and vital process. The use of drama is one of many innovative ideas. Our responsibility as educators is to examine new ideas with an open mind and either incorporate them into our program or discard the ideas. Regardless, the effort can make going to work an adventure.
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