The art and science of systemic wellness in Black communities: Qualitative evaluation of a multimodal theatrical production

Abstract

Background:

Edutainment has long been used as a strategy in health promotion and public health wellness interventions. In March 2019, a large US southeastern university hosted a multimodal theatrical production entitled From Colored to Black (FCTB). The play used a historical lens to broadly address social determinants of health such as disparities in education, access to health services, fair housing and health outcomes. This creative intervention was intended to encourage progressive, justice-oriented attitudes about historically disenfranchised Black communities in North Central Florida.

Methods:

Driven by an arts-based education approach and constructs from narrative transportation theory, the study employed directed qualitative content analysis to evaluate audience commentary and examine how a play on historic health inequities in Black communities could activate cognition, emotion and imagination for critical thinking about present-day wellbeing.

Results:

Qualitative survey data in response to the artistic presentation revealed the following subthemes: fascination, assumed truthfulness, satisfaction, feelings of inspiration, enthusiasm, negative attitudes, hopelessness and emotional disconnect.

Conclusions:

Edutainment continues to be a strong intervention tool. Feedback indicates audience members experienced both highly immersive moments and low transportation-inducing points that ultimately influenced critical reflection on some of the themes addressed in the play.

Keywords

Edutainment narrative transportation public health wellbeing

Introduction

Engagement with a health topic is an essential pre-cursor to critical evaluation (Cline and Haynes, 2001; Kreuter and Wray, 2003), focused information seeking (Graffigna et al., 2017; Strekalova, 2014) and health-related behaviours (Hornik, 2002) that enhance lifelong wellbeing. Good health is determined by one’s physical, spiritual and emotional condition. A broader way to think about health is by examining wellbeing, which considers wellness from both an individual and communal perspective (Baxter and Low, 2017). Together, health and wellbeing are influenced by a number of systemic social and economic factors that can determine health within a person’s situated environment (Baxter and Low, 2017; Lincoln, 2020). These factors include access to economic stability, education, social and community context, health and health care and neighbourhood and the built environment, as defined by the US Government’s federal initiative on health (Lehmann, 2019). Public health practitioners use prevention and intervention methods to address wellbeing by engaging these social determinants to promote good health (Masic, 2018). One approach commonly used in health promotion is entertainment education, or edutainment programmes.

Edutainment is a genre of entertainment that was designed to educate and encourage learning (Aksakal, 2015). Audience involvement plays a key role in an edutainment programme’s effectiveness at establishing behaviour change (Sood, 2002). Involvement is commonly conceptualised within two dimensions: affective referential involvement and cognitive critical involvement. Both types serve as precursors for increased self- and collective efficacy, as well as interpersonal communication between audience members (Sood, 2002). Edutainment programming commonly relies on elements of narrative-based techniques to craft a highly immersive, mentally transportation-inducing experience by using ‘direct exposure to media models and indirect social learning through interpersonal discussions’ (Wang and Singhal, 2016: 1003). Other factors that play a role in the effectiveness of edutainment are topically varied. Consequently, the persuasive effects of edutainment programmes can stem from the internalisation of employed narratives and critical application of the themes from the narrative to individuals’ own backgrounds (Singhal and Rogers, 2002).

Narratives in health promotion are used to showcase personal characteristics and activate psychosocial mediators of health-related behaviour change. Murphy et al. (2013) found that narrative, compared to traditional nonfiction formats, was more effective in increasing knowledge and changing attitudes. Furthermore, transportation, identification and emotion can cause shifts in knowledge, attitudes and behavioural intentions (Murphy et al., 2013). Research suggests that those engaged in health-related stories and narratives are more likely to seek additional health information and engage in discussions about health issues with their friends, families and doctors (Brodie et al., 2001). The goal of this study was to explore the effects of artistic performance on activating critical thinking about health equity and pathways to wellbeing. Specifically, the research investigated historical narrative and sought to explore the role of creative performance-based education in supporting the public understanding of social health and lifelong wellbeing.

Theoretical framework

Storytelling is an age-old technique that has been used to pass down oral histories, sustain social memory, entertain and enshrine moral codes. In an applied context, theatre and performance-based art have been used often as a medium to creatively tell stories about health and wellbeing (Baxter and Low, 2017). Arts-based health interventions have been useful among children and adolescents in educational settings (Joronen et al., 2008). Arts-based education to adult audiences has also been developed and evaluated in a number of applications. Building on rural folk systems of traditional art, the approach has proved successful in international public health communication efforts on various issues such as sexual health in South Africa (Durden and Tomaselli, 2012; Low, 2010) and malaria prevention in India (Ghosh et al., 2006). Scholars suggest this medium is compelling because it provides a venue for diverse communities ‘to connect and participate in a shared activity and transform their views of themselves and others in ways that . . . (can be) beneficial for health and wellbeing’ (Wimpenny and Savin-Baden, 2014: 14).

Using art in health education has been shown to be even more effectively persuasive when transportation is involved. Green and Brock (2000) define transportation as the extent of how deeply absorbed one can be in a narrative text experience (the text can be experienced visually, textually, through audio, etc.); it is conceptualised as a psychological state and/or mental process that blends attention, imagery and feelings. In the developmental stage of their theory-building, Green and Brock (2000) used Gerrig’s (1993) characterisation of transportation to conceptualise and ‘. . . capture its major dimensions, including emotional involvement in the story, cognitive attention to the story, feelings of suspense, lack of awareness of surroundings, and mental imagery’ (Green and Brock, 2000: 703). The three components of narrative transportation are cognitive engagement (cognition), emotional engagement (affective), and the generation of mental imagery (imagined presence). Humans begin with concepts or mental representations to make sense of the social world that surrounds them. Social cognition is made up of an interconnected network of concepts, or schema, that help individuals draw inferences and extract meaning from life processes. Cognition is also a mental process that is necessary for the acquisition of knowledge (Kunda, 1999). Although conceptually a loaded term, at its core social cognition is represented by two major dimensions: the cognitive and the affective. Cognitive processing is essentially thinking or converting thoughts into beliefs and attitudes. Affective processing deals with feeling, or understanding emotions (Badoud et al., 2017). Building off the aforementioned components, mental imagery is ‘the cognitive process of representing sensory information and cause-and-effect simulations in working memory’ (DeRosia and Elder, 2019: 639); in a way it is a visualisation of mental data from the cognitive and affective experience. Because this imagery is being enacted mentally, the representational content is perceived in a state of imagined presence (Hutto, 2015). Imagined presence can influence the social context of meaning-making by linking that mental imagery to suspended (dis)/belief and high levels of engagement (Waterworth and Waterworth, 2003).

Together audiences use these dimensions to process a narrative. In a high transportation state, individuals may be more inclined to distance themselves from previous experiences and schema, and thus be more apt to consider counter-beliefs that can act as a mechanism for changing attitudes related to the narrative being presented (Green and Brock, 2000). These shifts in attitude can lead to changes in beliefs, intentions and behaviours (Ajzen and Fishbein, 2005). Being in such a suspended state of reality can make one more susceptible to influence (Escalas, 2007). Conversely, those in a low transportation state may approach counterbeliefs with great scepticism (Russell et al., 2019). Transportation through narrative can cause cognitive and affective reactions, thus shifting a person’s beliefs, attitudes and intentions (Van Laer et al., 2013). These are all desired outcomes in persuasion and social marketing. Research has shown narrative transportation to be an effective tool of persuasion in various disciplines but notably in the case of predicting participation in cancer research (Neil et al., 2018), behavioural intentions to drink alcohol and drive (Gebbers et al., 2017), evaluations for personal enjoyment and empathy (MacDorman, 2019), success in commercial digital marketing (Van Laer et al., 2019) and evaluations of perceived hotel brand image (Ryu et al., 2019) among many other areas.

Activating transportation

Previous research indicates that the way a form of edutainment is perceived can affect how viewers identify with characters, as well as viewer self-efficacy and intention to change or adapt whatever behaviour is being persuasively promoted (Smith et al., 2007). In order to evaluate how immersive a production is for audience members, researchers use transportation theory dimensions as a coding frame to appraise audience comments for evidence of transportation (Green and Brock, 2000). The presence of a high transportation experience, as interpreted by comment feedback, is hypothesised to be a strong indication of audience attitudes. Previous research suggests that greater levels of transportation are correlated with pre-exposure support of the positions portrayed in the play, a reinforced willingness to being more empathetic towards those experiencing the social issues being addressed, and potential future support for behaviours and actions that would alleviate negative social conditions mentioned in a edutainment play performance.

Production background

In March 2019, a large US southeastern university theatre hosted a multimodal theatrical production entitled From Colored to Black (FCTB). Based on the playwright’s vision, FCTB integrates elements of local oral history, public health data and social activism. The play was designed with an artistic, yet justice-oriented lens in mind and sought to conceptually map connections between modern health disparity data and the troubling history of racially motivated behaviours that likely may have had an impact on Black community wellness in North Florida today (Center for Arts in Medicine, 2019). Its purpose was to engage audience members in a broadly based discussion about how current and historical vestiges of systemic racism are linked to social stigmatisation, as well as disparities in education, access to health services, fair housing practices and health outcomes among members of the Black community (McAvoy, 2019).

The play examines how history can be understood through the lens of lifelong wellbeing in the context of generational memory and civil rights histories from a localised perspective. For example, one scene recounts the experiences and lasting impact of the Rosewood Massacre, which was a racially motivated race riot that decimated a nearby all-Black community. Cast members address the mental and emotional trauma survivors experienced years after and its influence on race-based mistrust. In addition to post-traumatic stress, the displacement former Rosewood residents experienced also interrupted educational pursuits and their ability to earn regular income (Jones, 1997). This scene in particular uses a local historical narrative as a backdrop to engage audience members in social determinants of health (economic stability, education, social and community context, neighbourhood and the built environment) and the ways in which white mob violence compromised the health and wellbeing of an entire community. Additional scenes draw on this narrative to explore topics like generational wealth, epigenetics and other future implications with regard to the healthfulness of Rosewood survivors and their family members.

The play was constructed to inform audience members of the social determinants of health experienced by Black communities in North Central Florida, in the hope of persuading audience members to consider taking on or maintaining progressive opinions about race and social justice. Some major topics discussed in the play include the role of women during the Civil Rights Movement, ‘intergenerational stress and trauma, the significance of redlining, racist public policies on education and community health, the lasting effects of integration on Black education, and the portrayal of Blackness in the media . . .’ (Center for Arts in Medicine, 2019, paragraph 1). The play was written by University of Florida graduate Brittney M. Caldwell, who is also an up and coming African American playwright. Her thought-provoking work ‘incorporates dramatised civil rights era oral histories excavated from institutional archives into an analytical framework designed to educate audiences and provoke critical dialogue’ (Center for Arts in Medicine, 2019, paragraph 2).

The play was intentionally built around a narrative embedded with socially difficult discussion points, as a form of edutainment. The creators behind the production wrote and staged the play in a traditional theatre setting. The play centres on a Black family BBQ gathering at which family members discuss issues facing Black people today.

The play is presented in a transmedia storytelling¹ (Singhal et al., 2013) format. It weaves nontraditional vignettes throughout the backyard BBQ dialogue and includes still visual graphics with audio of music, narrated poems, scenes of live dialogue and video dramatisations of historical moments from Floridian history. These historical accounts were sourced from the Sam Proctor Oral History Programme. After the play ends, the cast and creators used an in-depth question-and-answer session to exchange reactions and feedback about some of the themes that appeared in the production.

Against this background, the research question to be explored in this study was how does a play on the topic of historic health inequities in Black communities activate cognition, emotion and imagination for critical thinking about present-day wellbeing?

Methods

Data sources

The original three performances of the play took place on 16–17 March 2019. The evaluation data were collected through paper survey forms that audience members received when entering the theatre. The evaluation study was approved by the University of Florida’s Institutional Review Board, and each survey was accompanied by an informed consent form. Audience members were provided with space to write open-text comments in response to the following questions, which were informed by the use of critical incident technique (Hughes et al., 2007): (1) what did you like about the performance and (2) what do you think could have been done differently?

In total, 197 survey responses were collected. Responses from 4 surveys reported ages under 18 and were excluded from the analysis. Also, 17 survey forms had missing information about the age of the responded and were excluded from the analyses as well to prevent the possibility of including responses from minors whose parents had not consented to their participation in the evaluation. The final dataset was based on 176 responses.

Respondents included women (N = 125, 71%), men (N = 47, 27%) and transgenders (N = 4, 2%). Respondents identified themselves as White (N = 85, 48%); Black (N = 51, 29%); Hispanic/Latinx (N = 12, 6.8%); Asian/Pacific Islander (N = 10, 6%); multiracial (N = 7, 4%); or of Caribbean descent (N = 6, 3%). Some selected multiple race categories. Their ages varied from 19 to 91 years old (M = 45.01, SD = 19.61).

Approach to data analysis

We used directed qualitative content analysis to answer the research questions formulated earlier (Hsieh and Shannon, 2005). This approach calls for the identification of a clear theoretical framework that guides data analyses and aims to enhance the understanding of theoretical constructs through the application of systematic analytic techniques. In order to evaluate how immersive the production was for audience members, we used transportation dimensions as a coding frame to appraise audience comments for evidence of transportation (Green and Brock, 2000).

Content was assessed using the three major facets of transportation as a theoretical guide: cognition, emotion and imagined presence. Emotion was used to assess comments that yielded strong feelings or denoted some sense of emotional involvement. Cognition referred to comments that implied cognitive reaction or focused attentive points in the play. Imagined presence denoted comments that made connections between portrayed topics in the show and personal mental representations.

Researchers’ Perspective

The study research team included a doctoral graduate student in health communication (Y.O.A) and two faculty members in programme planning evaluation (Y.A.L.S.) and creative health research (J.P.) respectively. The first author is a qualitative researcher who studies the intersections of identity, culture and communication in the context of health behaviour. Her research encompasses narrative storytelling in health interventions, as well as in the representation of Africa and the Black diaspora in global news and entertainment media. The second author is a health communication and education scholar with experience in educational evaluation and adult learning research. The third author is a public scholar that uses theatre to address social issues and community health. His expertise is oral history performance and he conducts translational research via the dramatic arts and educational videos. Collective researcher interest in this study emanated from the observation that open-ended survey comments had not been previously analysed and the authors’ belief that this dataset potentially contained rich information worth further exploration on the subject.

Results

The analysis focused on exploring the characteristics of three theoretically identified constructs related to transportation (cognition, emotion and imagination) as realised in the context of the show. Feedback was examined to interpret high transportation elements, or those that ushered one into a transportation experience versus feedback that was thought to reflect low transportation elements, or components that might have disrupted the transportation process. The following are subthemes and quoted supporting examples that developed through the coding process.

Cognition

Fascination over how informative audience members perceived the play to be

Many members of the audience mentioned they had no prior knowledge about some of the historical and statistical information shared throughout the play:

I loved the history of Gainesville + surrounding areas. I learned so much today. Everything was wonderful. (I) Even (liked) the conversation about issues within black culture.

I loved the performance, especially the aspects of local North Florida. I’ve lived here in this state through middle and high school and was never exposed to anything like the St. Augustine/Rosewood events.

The diverse range of perspectives, allowed me to see things in a different lens and question concepts I had not considered before.

According to insights from published reports on how to communicate social determinants of health, the Robert Wood Johnson Foundation recommends using specific examples to illustrate data that can add context to health inequities. The production’s historical vignettes instigated fascination and helped audience members fill knowledge gaps on past social issues. The play used the Rosewood Massacre to link the traumatic legacy of discriminatory violence to a compromised sense of wellness within the built environment for Black people in North Florida. This finding is particularly interesting because of this historic community’s proximity to a university community that is perceived to be socially progressive. Although a historical marker exists where Rosewood once stood, some participants who were previously knowledgeable about the racial massacre cited a lack of interest in the retelling of this local narrative, which is likely the reason for such unexpected fascination among other participants who were previously unaware. Thus, the legacy of a pivotal narrative remains hidden in some ways.

Assumed truthfulness associated with the historical portrayals and statistical information provided

Both historical portrayals and the statistical information presented were described as being especially authentic tools for engagement that made the points mentioned feel more factual:

It was very authentic and spoke to history in a way that uncovered some great truth.

[I like that] . . . it includes real facts and stats for the topics they were talking about or trying to prove.

As a tenet of source credibility theory (Hovland et al., 1953), perceived trustworthiness has a significant influence on audience intention to adopt behaviour changes featured in persuasive messaging (Ismagilova et al., 2019). Thus, audience members may likely be more receptive to health messages they believe to be true. Interpretation of these narratives can be filtered through multiple perspectives. Originally, the stories featured in FCTB were sourced from a digital oral archives. Historical accounts were collected from North Florida residents by students and faculty members trained in interviewing techniques. This means the interviewers and storytellers co-constructed the memory of a past event. Next, the play’s producers reimagined that co-constructed reality through recorded videos. So, although we the researchers may see the stories as being multilayered, they coalesce in a way that resonates as true.

Emotion

Satisfaction with how they personally identified with the characters and content (stereotypes and realities) presented

Several audience member comments mentioned how the play felt like an accurate reflection of some of the more nuanced feelings that emerge when discussing race and Black culture. The cast and dialogue were described as having strong cultural competence and relevance respectively in addressing such sensitive social issues. This may have been supported by the production’s straightforward and unapologetic perspective. Audience members believed the project to be more authentic because of how bold and honest the writing felt:

I truly enjoyed this performance. I felt it was relatable to my life as an African American woman and it was well put together and performed!

I liked that the writing and performance were fierce and forthright. The choreography was excellent, and the scope of topics was good. I liked the presentation on how Black history is treated.

As mentioned above, social and community context is one of the five social determinants of health. Civic participation falls under that specific domain. Activities such as voting, volunteering and coming together for informal community events – are all civic-minded tasks one can undertake to engage psychosocial wellbeing. Ironically, by attending the production, audience members were actively participating in civic social wellness, while also learning about the ways in which community wellness has been historically stripped from Black communities in North Florida.

Feelings of inspiration from the resilience attributed to individuals in the Black community

Several viewers described certain scenes and points of discussion as valuable and essential:

Covers many important issues. Appreciate focus on health disparities and public health. Loved the focus on local history, being a student from out of town much of the local information was new.

They made the material engaging and accessible. Learning about this history should be incorporated throughout the town.

Enthusiasm with regards to the creative and diverse approach to how the play was presented

There were positive comments about enjoyment over transitions from live to recorded components. Some audience members also responded well to the cast’s deviation from tradition by breaking the fourth wall:²

I loved the video recreations of the oral history interviews and the dynamism of the stage.

Incredibly informative. Well organised categorically and the diversity in storytelling mediums.

The continuity between filmed portions and the presentation was marvelous . . .

Enthusiasm and inspiration are important and useful emotions when it comes to communicating persuasively and processing information in a way that motivates future action (Booth-Butterfield and Booth-Butterfield, 1990; Thrash and Elliot, 2003).

Hopelessness in response to being confronted with health disparities linked to systemic racism

Some comments described the play’s vignettes as being too pessimistic without emphasising actionable solutions to some of the social ills discussed:

I would like to be informed on ways I can actually help.

I think at the end their should have been a segment to reunite all people of colour, even the whites because not all whites are racist. And to encourage the people to not reciprocate that same behavior but to stand with rightness and not skin colour.

Civic-minded political participation in local and national elections was encouraged through the nature of this educational intervention, and a few attendees remarked how they valued the new information they learned. But some audience members reacted with frustration about the play not directly addressing more specific ways they could help combat the race-based health inequities featured in the play.

Imagination

Negative attitudes in response to times when the production’s tone was perceived as being too much of a social reprimand

FCTB includes several scenes that showcase Black American church services. In these scenes and other casual family scenes, castmates demonstrate expressive mannerisms common in charismatic religious services, including the use of a strong moralistic attitude. Some audience members were critical of this sermonising style, describing it as preachy. In the first backyard BBQ scene (shown in Figure 1), characters discuss geographical health inequities in Gainesville and Jacksonville, while projecting authentic redlined maps from the 1930s and current health data maps. The purpose of the segment was to show the correlation between historically Black neighbourhoods and poor health outcomes in the same areas. Though intended as a visual point of reference, the style is common in US university courses, which is perhaps why that segment may have been perceived like more of a lecture:

The health issues come across as more forced and preachy- less engaging.

Seemed extremely preachy/ like a textbook. Important to inform about race, but not in the rigid, unoriginal way of having live actors sit around the couch playing board games and unrealistically discussing Black history.

More story, less lecture.

Figure 1.

Snapshot of FCTB cast mid-scene as they address racial politics and police violence (Center for Arts in Medicine, 2019).

The last quotation above highlights a desire for a change in the perceived delivery of the play’s content. Although the script is derived from actual historical accounts, this particular attendee seemingly understands the text as more of a social rebuke towards the unjust realities of Black life instead of something to enjoy. Themes from the play, such as race-based police violence, white flight and other racist practices may feel especially uncomfortable for some. Learning to interrogate issues of race and justice can be difficult, even if these issues are introduced through an entertainment-based format. These comments represent resistance or rejection of how some of the motifs were presented in the play. It is possible that the audience member in question processed the thematic portrayals in FCTB in a way that was in contradiction with their imagined sense of self, resulting in a sort of attitudinal backlash.

Emotional disconnect

Similar opinions surfaced through another subtheme under the imagined presence theme. Sentimental detachment was noted in viewer commentary because some remarked feeling like parts of the play seemed too biased, especially when including punchy lines about race or President Trump:

Was a bit offended by the ‘whiteface’ (see Figure 2). Seems a bit weird to complain about blackface and then do the equivalent.

I did not appreciate opinions shared that were not historically (accurate), for example Trump’s wall. I personally like the wall (and) there were others (there that agreed).

One-sided show, too much negative about Black people. Trump? Doesn’t feel like a history show. Feels like an ongoing complaint.

Figure 2.

The play’s creative directors wanted cast members to provocatively wear white face masks. This theatrical choice was intended to agitate white audience members into critically confronting white fragility, with relevant oral history narratives as a juxtaposed backdrop (Center for Arts in Medicine, 2019).

The comments above are evidence of tension between the play’s content and the political positions held by certain audience members. For example, if one of the quoted attendees is a devout Trump supporter, content from the play made strong suggestions about President Trump’s character, which could also apply to his political fanbase. The negative associations ascribed to the President would then cause possible discrepancies between some audience member’s sense of self and the projected reality that appeared in the narrative. Emotionally detaching from the material would be a way to preserve a positive self-concept by dismissing elements from the playscript. These critiques indicate points of personal disengagement from certain viewers. This disconnection also likely created an interruption in the transportation experience.

Discussion

This study used a directed qualitative analytic approach and a tool of analysis that was conceptually informed by edutainment and narrative transportation theory (Green and Brock, 2000). Findings from the research aim to make contribution to a body ‘of research [that is] often focused on the impact of edutainment on communication, persuasion, and learning outcomes (Haytko, 2006; Kurthakoti et al., 2013; Singhal and Rogers, 2002)’. (Chan, 2019: 200). Published research using transportation dimensions typically uses less complex presentation structures, or more traditional unimodal narrative text(s). FCTB is unique because the play’s format marks a departure from more conventional edutainment interventions in social research studies. Cast members and viewers had the opportunity to be interactively reflexive in their reactions to the content as it was being performed and during question and answer sessions. However, the diverse, multimodal presentation did presented challenges to the evaluation process. If edutainment is intended to educate (Aksakal, 2015) and trigger deep narrative engagement (Bourgeon-Renault et al., 2019), then information and meaning have to be clearly conveyed. Some viewers expressed confusion about the intention of certain elements in the narrative, which may have served as a distraction to the ultimate goal – transportation.

Tangential to the resulting construct-driven subthemes, inconsistencies in sound quality and dissatisfaction over the length of certain parts of the (live and recorded) performances were mentioned in audience critiques. We did not interpret these as legitimate cognition-inhibiting factors because in some instances the sound and show length were either an artistic decision or unintentional consequence beyond the producer’s control; ancillary issues like sound staging, vocal projection and speaking pace can affect a viewer’s ability to hear or understand dialogue. When a narrative’s resonance is low, long production times can provoke restlessness. Both of these factors can disrupt the immersion process necessary for transportation. This finding is consistent with the literature that asserts how important the stability of the interaction environment is to a viewer’s emotional response and overall evaluation (Chan, 2019).

Another finding observed from audience comments concerned the narrative itself. Although the play’s focus highlighted social determinants affecting the health of Black communities, one segment of the show also described some of the issues that LGBTQ + individuals’ experience. Some comments alluded to an awkwardness in the narrative’s content, describing this moment as misplaced. Integrating sexual and gender minorities in a play centred on racial minorities hindered perceptions of the narrative for some, and these participants emphatically reiterated that the experiences of racial and sexual minorities should not be compared. This unexpected interruption in the narrative may also have had an impact on the activation of transported thinking and receptiveness to the health inequities described throughout. As a possible solution to similar transportation interruptions in the future, the playwright might want to consider expanding the play to address more intersectional themes throughout instead of just one or two scenes. Creating a work that focuses squarely on issues faced by members of intersectional groups (i.e. Black gay men, Latinx women) could be another approach. Further exploration in a Q&A session or via follow-up interviews could help the play’s creator interrogate discomfort around intersectional identities that could be used to deepen character development and theatrical dialogue to strengthen future behavioural intentions.

In addition, the creators of the play took on the major task of including a comprehensive range of relevant historical and current events. A notable number of audience commenters criticised this decision because they said that certain pivotal historical events deserved more attention but seemed rushed due to time constraints. The artistic choice to include or exclude certain moments could have implied some aspect of negligence in the construction of the narrative. This assumption could have an impact on trustworthiness and ultimately transportation.

Limitations

In terms of the study’s limitations, the accounts of audience members did not constitute a thick narrative and therefore did not yield the type of detail that could be used to extract certainties about how to guarantee a high transportation state. Moreover, self-reported data may be subject to the biases and judgements of participants providing feedback. Ontologically, there is no way the researchers can know a participant’s propensity to experience transportation; this can vary between people. The researchers also have no information on the broader context of audience members’ lives before, during or after the production. It also was not feasible to assess in-depth the personal beliefs and sensitivities that may have affected audience perceptions of the play’s topic or post-play discussion.

Implications for practice

From a practice perspective, the play’s producers can use the thematic feedback to focus future production messaging in a more direct way, thereby bolstering the play’s potential as a vehicle for transportation, and increasing its success as a health and wellness intervention.

Analysis of audience reactions revealed that the performance did indeed prompt thinking about historical inequities that affect the quality of health and wellness of Black Americans in North Central Florida. To build on the cognitive reactions mentioned above, most notably hopelessness, the show’s producers could use post-performance discussion to identify action items, such as the ways in which audience members could support local programmes or organisations working to build health equity for groups vulnerable to dismal social determinants of health. Future programmes could also use an edutainment format and transportation strategy to educate audiences on how to be participatory in supporting lifelong wellness for specific groups in various spheres of wellness.

In an applied healthcare planning context, performance-based edutainment that incorporates historical narratives can provide viewers with a more comprehensive understanding of health issues and disparities. For example, one cannot truly understand the depth of issues such as low health literacy and medical mistrust among Black communities in North Central Florida without considering the historical, racial tensions that led to such a position. Involving communities that are both affected and unaffected can influence change by promoting a fuller understanding of relevant background. Integrating community engagement by people who are affected in different ways can also empower those affected to take action, while inspiring those unaffected to become supportive communal allies.

Footnotes

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

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