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.