Adapting a Theater Outreach Program During the COVID-19 Pandemic to Promote Cervical and Colorectal Cancer Screening
Introduction
With funding from CPRIT and other sources, the Office of Outreach and Health Disparities at the Dan L Duncan Comprehensive Cancer Center has developed and implemented a robust Theater Outreach Program (TOP) to reach medically underserved racial and ethnic minority populations to promote prevention of colorectal cancer (CRC) and cervical cancer (CxC), as well as other common cancers. The program, which was initiated in 2010, uses an evidence-based community theater approach to educate communities about cancer risk factors, current screening guidelines, and available community resources and services. Due to COVID-19 social distancing measures, live monologue performances were placed on hold starting March 2020; however, adaptations were made to continue to deliver educational messages through a virtual and hybrid format. Here we describe adaptations and the results of our adapted program, which we implemented in Year 1 of our current program.
Methods
The monologues were written and developed by professional playwrights and included key messaging concepts developed with oversight from the Clinical Advisory Boards and program staff. The CRC monologues include The Bottom Line and La Vida es un Sueño, targeted at African American and Spanish-speaking Hispanic communities, respectively. The monologues with a CxC focus include A Well-Tuned Engine and Mi Decisión, targeted to African Americans and Spanish-speaking Hispanics, respectively. Initially, after the declaration of the pandemic, our presentations were fully virtual without an in-person audience using Zoom technology, including filmed versions of the monologues and other session components (i.e., Q&A period, post-performance survey). However, as the pandemic eased, we adapted our TOP to a hybrid format using filmed versions of the monologues with an in-person audience held at community venues. Both viewership and survey completion were used as records of participation. Post-performance surveys were completed on paper for live audiences and electronically (through a QR code link) for virtual performances. Gift cards were raffled to encourage participation in the survey. Additionally, we repeatedly emphasized during the sessions the importance of obtaining feedback for program evaluation and improvement. A two-sample test of proportions (which assumes independent samples) was used to measure participants intentions to screen before and after the performance.
Results
During Project Year 1 (August 31, 2021 – August 30, 2022), we delivered three virtual and 12 hybrid performances, reaching a total of 344 audience members. Eleven of these performances presented our CRC monologues (La Vida es un Sueño and The Bottom Line), and four presented our CxC monologues (Mi Decisión and A Well-Tuned Engine). Two hundred fifty attendees completed an evaluation survey to assess their intention to screen, with a response rate of 72.7%. For CRC (n = 168), the proportion of participants indicating a higher intention to screen increased by 19% after the performance, from 58.1% to 77.1% (p<0.001). For CxC (n = 82), the proportion of participants indicating a high intention to screen was similar before and after the performance: 63.9% and 62.5% (p = 0.8525).
Conclusion
Given the safety concerns during the COVID-19 pandemic, the adaptation of our TOP to virtual and hybrid presentations increased portability and was readily integrated into already scheduled webinars, community events, conferences, and other group meetings. Furthermore, these adapted strategies are now integral formats that we continue to utilize for reaching our targeted communities with CRC and CxC screening messaging. As we slowly transition back to offering live monologue performances, virtual and hybrid presentations remain popular formats with our community collaborators and the residents we serve.