Tuesday, April 5, 2011

Improv Theater is an Effective Sexuality Education Teaching Method: “Imagine That”!

As a teenager in high school I was a proud member of an improvisational (improv) theater troupe in Spartanburg, SC called “Imagine That.”  Improv theater is defined simply as: acting without a prepared script (United Nations Y-PEER, 2003). We would perform skits or scenes on social issues affecting our peers and adults such as: individuality, depression, suicide, teen pregnancy, discrimination, racism, drug and alcohol abuse, violence, STD’s including HIV, date rape, peer pressure, bullying, etc.  We would perform about 5 of these scenes at schools, churches, community centers, public libraries, special events, correctional facilities, as well as at national youth conferences around the country. Our director would process each scene with the audience facilitating discussion about what they experience, and the positive and negative outcomes they perceived, thus forming an hour-long show or presentation.
Why should you care about this? Well, besides it being a really special time in my life that helped shape who I am as a person today that has helped steer me towards a career as a sex educator, I participated and witnessed first hand an extraordinarily effective teaching method.  I believe the interactive education we carried out by performing improvisational theater scenes was much more effective than programs such as “D.A.R.E.,” that was determined to either have no effect or a detrimental effect on lowering rates of teen drug use (Kanof, 2003). “D.A.R.E.” was a federally funded Drug Abuse Resistance Education curriculum used by schools nationwide in the 1990’s.  It and other programs like it used in classroom and authoritative instruction settings informed students that whenever they were tempted by their peers to use drugs to remember the “NO USE” pledge they signed, refuse the offer, and encourage the student to report the incident to an officer of the law (www.dare.org).
I believed that our method of using improv theater was effective, especially with our teenage peers, because it drew in or “hooked” the audience from the beginning.  At the start of every show we would perform an opening scene that was loud, eye-catching, attention grabbing, unnerving, scary, but most importantly thought provoking and emotional. It would usually involve us (the cast) coming to life from frozen positions dispersed throughout the audience wearing white facemasks interacting with one another and the audience as we worked our way up to a picture portrait grouping in front of the auditorium, cafeteria, or stage. Trust me, people would scream, gasp, and have to go use the restroom sometimes to prevent spoiling themselves because they became so excited!
However, looking back, I think it was the “hook” we provided with the opening scene as well as the interactive audience participation in verbally processing their feelings and thoughts about what they just saw us perform theatrically. Therefore, I have always planned to use improv theater as a teaching method someday when I am advising a peer health education group on a college campus. Yet, I started to wonder if improv theater was a truly effective teaching method or if my involvement in the troupe just made me leap to assumptions. Therefore, I have sought out research that supports my theory that improv theater is in fact an effective teaching method for health and sexuality education, especially when using peer educators.

            Using theater as an effective teaching technique in health and sexuality education is supported by numerous theories.  The first theory and the one that offers the most support for theater in health education is the theory of reasoned action that states that “the intention of a person to adopt a recommended behavior is determined by: 1) the person’s attitudes towards this behavior and his or her beliefs about the consequences of the behavior, and 2) the person’s subjective viewpoint about an issue and the normative or society’s standard based on what others think he or she should do, and whether important individuals approve or disapprove the behavior” (Y-PEER, 2003).
            Therefore, peer health educators are the perfect tool because they have the potential to highly motivate their peers to change their behavior based on the fact that adolescents are significantly influenced by the perceived expectations of their peers, displayed through live theater. For example, a young woman who thinks that using contraception will have positive results for her, will have a positive attitude towards contraceptive use” especially if she perceives that her peer (in this case the peer health educator) expects her to do so (Y-PEER, 2003).  This scenario could easily be extrapolated into a 5-7 minute improv theater scene highlighting the positive and negative outcomes of a character debating on whether or not to use contraception. In other words, peer health educators show that it is cool to engage in healthy behaviors, thereby making it a standard in society. If an individual is not using condoms when they have sex, then they could potentially harm their reputation or likability with their friends or peer group.
            While this is just one particular theory, Bandura’s Social Learning Theory, Beck’s Cognitive-Behavioral Therapy, Moreno and Blatner’s Role Theory, Tompkin’s Script Theory, Roger’s Diffusion of Innovations, Kolb’s Experiential Learning Theory, and Miller’s Chunking Theory all provide theoretical support for using theater in peer health and sexuality education. Elaboration of exactly how these theories provide support within the context of peer health education can be found in Y-PEER’s Peer Education: Training of Trainer’s Manual (Y-PEER, 2003) available online at the web address listed below.

Theories are a respectable foundation, but what about real life implementation and evaluation to discover if the theories actually apply and produce sound data that theater in health education is effective? Accordingly, several researchers have evaluated the effectiveness of using theater in peer health and sexuality education.
 Cimini, Page, and Trujillo in 2002 found that peer-led improvisation theater was effective in reducing high-risk behaviors associated with alcohol use and increasing protective behaviors. Another pre-post test analysis study which evaluated Planned Parenthood’s New Image Teen Theater revealed that participants reported “after viewing teen theater, more willingness to discuss sexual topics (t(80)=10.01, p.001), a greater intention to use birth control (t(43)=3.02, p.01), and greater sexual knowledge (t(92)=10.01, p.01) (Hillman, et al, 1991).
A researcher in Canada performed a case-study methodology on four groups of high school students and their peer leaders that resulted in “reports of increased self-confidence to reduce risky behavior, increased communication about sexual health issues, the development of greater compassion and tolerance, along with the desire to avoid stigmatizing HIV-positive individuals and sexual minorities” (MacIntosh, 2006). 
Finally, a WHO and UNAIDS-sponsored review assessed community-based peer education programs that targeted youth in lower-income countries that directly effected behavior change.  This review discovered 3 of 3 programs showed significant reductions in the number of partners, and 5 of 7 programs showed increases in condom use.  Most of the programs included in the review were able to reach large populations of youth, distribute condoms, and in some cases, change community norms around youth and sexual risk taking (Adamchak, 2006).
As one can see, theater peer education has been found effective in changing behavior and attitudes of adolescents across the world. It is also the recommended teaching method of several well-known and respected organization such as the United Nations, World Health Organization, and Youth Peer Net. Therefore, peer education is practiced worldwide despite the lack of a large peer-reviewed body of evidence demonstrating its effectiveness. While we may not currently have the means or methods to determine the extent of effectiveness of theater peer education on participants lives five years out, it has proven a crucial tool to accessing hard to reach audiences in diverse cultures (Y-PEER, 2003, Adamchak, 2006).
My hope for the future is that researchers will be able to show that not only is theater peer education effective, but that it outstrips many other teaching methods that are now outdated, or in other words do not engage the modern student. I encourage sexuality educators to utilize the Training for Trainers Manual (Y-PEER, 2003) listed below as well as any continuing education courses they come across that will prepare one to employ peer theater education. For it, I believe, is the most promising solution today for connecting with adolescents on a level where they become open to discussion and actually begin to change their behavior.

Adamchak, S. E. (2006). Youth peer education in reproductive health and HIV/AIDS: Progress, process, and programming for the future. Youth Issues Paper 7. YouthNet.
Cimini, M.D., Page, J. C., & Trujillo, D. (2002). Using peer theater to deliver social norms information: The Middle Earth Players program. Report on Social Norms 8(2).
Hillman, E., Hovell, MF., Williams, L., Hofstetter, R., Burdyshaw, C., Rugg, D., Atkins, C., Elder, J., Blumberg, E. (1991). Pregnancy, STDS, and AIDS prevention: evaluation of New Image Teen Theatre. AIDS Education Prevention, 3(4), pp. 328-40. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1777341
Kanof, M. E. (2003). Youth Illicit Drug Use Prevention: D.A.R.E. Long-Term Evaluations and Federal Efforts to Identify Effective Programs. Washington, DC: General Accounting Office.
MacIntosh, J.M. (2006). Theatre-based peer education for youth: A powerful medium for HIV prevention, sexuality education and social change. University of Victoria. British Columbia, Canada. Retrieved from http://gradworks.umi.com/NR/30/NR30158.html
The D.A.R.E. Mission: Teaching students good decision making skills to help them lead safe and healthy lives. Retrieved on 4 April 2011 from http://www.dare.org
United Nations Y-PEER. (2003). Joint Interagency Group on Young Peoples Health: Development and protection in Europe and Central Asia – Sub-committee on Peer Education. Peer education: Training of trainers manual. Retrieved on 12 March 2011 from Youth Peer Education Electronic Resource.


  1. I definitely agree that peer education and theater can have a significant impact on education. Thank you for providing some of the research that backs this up. I have seen firsthand how theater and improv can create a fun and enjoyable educational environment. There is a local improv group who uses theater to discuss sexual health topics and recently I had the pleasure of seeing one of their performances at a teen summit. The actors are slightly older than high school age, but certainly very relatable to the age group and they create a performance which generates discussion about topics very close to teens’ lives. The particular event I saw was a skit on sexual communication in which audience members were given a role in determining what the characters should do during the play. The actors would perform a segment of the play and then ask the audience what the characters should do next. The audience would vote and then the actors would act out the next portion, based on audience decision. Not only was this a great way to engage the audience, but the play itself generated a significant amount of discussion among the audience at the end. Based solely on my observation of the participation and interest of the group, it seems that this method would definitely be very helpful as an educational strategy. It is also in line with Gardner’s theory of multiple intelligences and the importance of the differentiation of instruction. I certainly agree that peer education and theater should have a place in sexual health education. Perhaps collaboration between health teachers and theater teachers would be a good place to start.

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  3. This is an amazing topic! When I was in high school in Puerto Rico we all had a million questions about sexuality and no one would address these, but we were invited to see a play called "Fotomontaje" (a word used to described a picture that has been planned and thought of before hand) and that was the first time that many of my questions were answered. Needless to say high school students were never again allowed to attend but I truly enjoyed the honesty. SO yes I agree peer education and theater have and should have a place in sexual health education. It helps people see and hear important information through other characters making it non-threatening and if the topic is controversial the likelihood that people will listen are higher. It brings topics to the surface that some may not have thought of and it also provides information in a way that people are more willing to evaluate. I also agree with Rebecca collaboration between health teachers and theater teachers would be a good place to start and a field in which some sexuality educators can make a difference.
    I wanted to share information on a program that took place in Vietnam titled Participatory theatre in sexuality and reproductive health education for young people, this is a great example of how peer educations and theater can provide effective sexuality education. The aim of the project was to improve young people’s knowledge and attitudes about sexual reproductive health issues, including HIV prevention; and to encourage healthy behavior related to sexuality and reproductive health of young people and adolescents in Hanoi and Nghe An.
    These are some of the feedback the program received:

    -“The play on HIV and AIDS helped us understand the routes of HIV infection. Now we know
    that everybody would be infected, so we should not discriminate HIV positive people” (Focus
    Group Discussant, Nghe An)
    -“These performances create a cheerful and comfortable atmosphere, and the story is so real.
    Thus we have feeling that we are a part of the play” (Male student, 16 years old, Ha Noi)
    Free listing of youth’s impression about ITT performance: “Useful”, “Interesting”
    “Informative”, “Delicate” “Funny”, “Humorous” “Friendly” (Female Focus Group Discussant,
    Ha Noi)
    -“We have opportunities to ask them in person our questions and concerns during or after
    performance” (Girl, 21 years old, Nghe An)
    -"This kind of education is more appropriate because it allows us to interact and explore
    deeper information. We cannot have this benefit when we learn from text book or in class
    room. Even though our teachers are good, we are still too shy to ask" (Girl, 17 years old, Ha


  4. Bravo, Caleb! I love how you combine your personal interests with the theories to make a great case for improv theater in sexuality education. I’ve been to theater performances with discussion at the end and I thought that the discussion was a really valuable piece. I’ve also been to improv performances (just the straight-up comedy kind) that were really fun and I really admired the performers for their ability to think on their feet. I think the humor aspect of improv would be very helpful for discussing sexuality. When I’ve been to an improv show, by the end the audience was in a really great mood and there was a sense of community. That atmosphere would be really beneficial to sexuality discussions.

    I also like your idea of the “hook” as a vital first impression. The hook is important, even in a non-theater teaching environment. Whenever I make a mix CD I always carefully consider the first track. I want to pick something that will make the listener think “wow, this cd is going to be great!” So for teachers, whatever happens at the beginning of the lesson, whether that’s the way you introduce yourself or the icebreaker activity, you want the learners to think positively of it. A good “hook” or a good first impression will help make the rest of the lesson go as effectively as possible.

  5. Thank you for posting all the research related to the effects on behavior change. However, I would be interested in ascertaining whether those effects were long-term. When I did my master's thesis (many moons ago) evaluating HIV peer-educators in Uganda, the research seemed to show that there were no positive long-term effects on behavior change. This was disappointing to everyone who felt that they were benefiting from the peer programs - mostly the peer advocates themselves.

    However, I propose that the theater you describe is similar to role-playing activities, which incorporate principles from Knowles’ (1984) theory of andragogy and experiential learning (Rogers & Freiberg, 1994). Improv theater could possibly be even more relevant if the learners were somehow involved in creating the scene. At the least, it would be important for learners to debrief the scene afterwards and discuss the broader applicability of what they observed..

  6. Hey Shannon,

    Thanks for your response. Your experience in Uganda must have been amazing! I cannot wait to go abroad and do international health and sexuality education.

    Yes, unfortunately there is currently no research that indicates that improv theater peer education has any long term affects on the audience it is presented to. I believe this is because such long-term research is usually more difficult and expensive to perform, as well as what little research that has been done to that level found no significant changes.

    However, I can tell you from personal experience that being a peer educator myself going up definitely had a significant impact on me. I have never engaged in the use of hard drugs, nor will I ever, I did not drink until I was of legal age, I am one of the most open-minded individuals I know out of my peer group in South Carolina, and I learned the importance of knowledge, affectional and interactive education, and social support. All of these things have made me a better person today than I would have been. I attribute all of these lessons learned to my involvement as a peer educator during high school and throughout college.

    I believe there is also research that indicates long-term positive affects on individuals who are peer educators (not necessarily within the realm of sexuality or improv theater), but just general peer education on peer pressure, drugs, alcohol, etc. I am having a hard time finding the sources right now, although I know I have read such in a few articles at one time. I will continue to look for these & post them when I do find them, or if someone else comes along these, I urge you to post what you find as well.