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, examining health inequities and social determinants of health, it has increasingly acknowledged the roles of culture and trauma in determining health outcomes. The field has responded by modifying some research practices, but it has continued to rely on conventional methodologies, with few options designed specifically to foreground trauma- and cultural-responsiveness. Unfortunately, to the extent that conventional methodologies require health to be defined, communicated, or valued according to dominant norms, they risk perpetuating inequities. The field's shift to the social ecological approach demands methodologies that: increase inclusivity and access; elicit and apply diverse knowledges; ascertain effects of social factors; and examine how attributions of meaning affect health.
Using the Public Health Innovation Model, with grounding in critical theories, hermeneutics, photovoice literature, and research regarding arts in health, this study developed and tested three methodological prototypes for research regarding 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 collected creative writing as part of a themed citywide writing contest, and the third obtained the script for a play about sexual and relational violence, written and performed by local survivors, without researcher elicitation.
This study analyzed the prototype-generated data regarding population experiences, needs, assets, and priorities; it then compared these to data from conventional violence-related surveys administered among each sample population. Finally, it evaluated all methods for quality/quantity of information and trauma- and cultural-responsiveness.
Arts-based findings addressed 64-89 percent of the same variables as surveys, while surveys addressed only 36-49 percent of the variables addressed in arts-based data. The prototypes generated impactful insights unavailable via surveys, such as unconventional definitions of violence. They also juxtaposed needs with assets, accommodated expressive choice, and involved minimal researcher intrusion—rendering them trauma- and culturally responsive. The prototypes aided disclosure (thus improving data), were time- and cost-effective, supported community-led health education, and offered significant potential for research reciprocity. As such, they offer promising models for continued methodological innovation in advancement of health equity.