[Winner of the University of Louisville’s 2019 Prize for Outstanding Dissertation]
Innovation & Equity in Public Health Research
Testing Arts-Based Strategies for Trauma-Informed, Culturally Responsive Inquiry
As the field of Public Health has shifted from a biomedical paradigm to a social ecological approach, focusing on health equity and social determinants of health, it has increasingly acknowledged the roles of culture and trauma in health outcomes. The field has responded by modifying some research practices, but it continues to prioritize conventional methodologies—with few options designed to foreground trauma- and cultural-responsiveness. Unfortunately, to the extent that conventional approaches require health to be defined, communicated, or valued according to dominant norms, they risk perpetuating inequities. Health equity therefore requires the development of research methodologies that increase inclusivity and access, elicit and apply diverse knowledges, reduce intrusion, and incorporate sociocultural factors.
Using design thinking, and drawing upon critical theory, hermeneutics, photovoice, and arts-in-health research, this mixed methods study developed and tested three methodological prototypes for researching a potentially traumatizing topic (violence) among a vulnerable population (young women ages 11-21). The first prototype collected creative writing from an ongoing youth detention intervention, the second utilized a themed citywide writing contest, and the third obtained the script fora play about sexual and relational violence, written and performed by local survivors without researcher elicitation.
All prototype-generated data (combined n= 126) were iteratively analyzed for documented experiences, needs, assets, and priorities related to violence. Four conventional violence-related surveys, administered among the three sample populations (combined n= 1862), were also analyzed. Extensive comparative evaluations were then conducted of all findings and methods, assessing quality/quantity of information, trauma responsiveness, and cultural responsiveness.
Findings from the arts-based methods addressed 64 to 89 percent of the same variables as the surveys, while the surveys addressed only 36 to 49 percent of the arts-based data variables. The three prototypes juxtaposed needs with assets, accommodated expressive choice, and involved minimal researcher intrusion—rendering them trauma and culturally responsive. They also generated impactful insights inaccessible via surveys, such as unconventional definitions of violence. The prototypes aided disclosure (thus improving data), were time- and cost-effective, and offered significant potential for research reciprocity. As such, they offer promising models for continued methodological innovation in advancement of health equity.