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I never thought I'd be sitting here writing poetry about abortion, but here I am.

Notes from co-producing recommendations for policy and practice with health professionals in Northern Ireland.

Co-producing knowledge is often proposed as way to ‘build bridges’ and establish equitable partnerships between academic institutions and research participants in the health system. But how might the co-production of knowledge and policy-relevant recommendations with health professionals work in practice?

In this blog, I present the creative co-production process I used to facilitate a safe and reflective space for nurses and midwives to discuss the issues around abortion care that were raised in my PhD research. Based on the interview data I collected, participants and I generated recommendations for how policy and practice can improve health professional’s knowledge on abortion care in Northern Ireland, and in turn make the health system a safer and more compassionate place to seek abortion care. These insights may provide useful inspiration for other researchers considering involving health professionals in the analysis of data on a stigmatised research topic.

What did the co-production process aim to achieve?

I used co-production sessions with five participants with the aim to 1) allow them to co-own the interview data collected in my PhD project, 2) to co-generate recommendations, and 3) create a safe space to talk about the topic of my interview data – abortion service delivery in Northern Ireland. Three midwives attended a group session, and two nurses joined one-on-one sessions (scheduling challenges!).

Step 1: Warming up with ‘a line of discovery’

Sessions started off by making commitments to 1) protect confidentiality, 2) respect each other, 3) and to support each other emotionally if needed. I then adapted an Alliance for Choice[2] creative workshop activity and invited participants to write a chronology of their interactions with abortion along “a line of discovery”. We reflected on: “what started the conversation?”, “what feelings did they associate abortion with?”. This helped participants to start writing, thinking, reflecting, and to share their experiences. It laid the groundwork for the following activities by allowing us to let go of the formality of our professional identities.

Figure 1 E.g. of a line of discovery drawing from midwife participant

Step 2: Reanimating data using blackout poetry

Archivists, activists, and academics have used techniques to “reanimate data” to explore change and continuities in intimate lives over time. Blackout poetry is used in the social sciences to generate a deeper connection with material, reveal the ghosts in a narrative and hold a mirror up to our analyses. It can also help researchers to reflect on their emotions when engaging with their research  I used blackout poetry in this workshop to give participants a tool to engage with the research data, and to explore how my gaze on the study data may differ to theirs.

To do this, I distributed quotes from my interview data that highlighted tensions between localised and authorised forms of knowledge. I invited participants to work with creative materials (card, pens, scissors, tape, and glue) to rehash the quotes, reveal a hidden story, using words that “glow” and resonate with them. They enjoyed the task, taking their time to pass around the quotes, consider the ones that meant something to them and explore ways of using the creative materials. One participant summarised the feeling in the room: "I never thought I'd be sitting here writing poetry about abortion, but here I am." They accompanied their creative work with a title, note on what the poem is telling us and what needs to change. They also included annotations, doodles, and drawings, working with the materials they had to hand.

The participants’ work engaged with themes in the data: the urgency of time in abortion care, intersectionality of abortion restrictions, and poor resourcing of abortion care in Northern Ireland. They chose to work with testimonies that came up in the interview data about the de-prioritization of abortion care in hospitals, the injustice of the pre-2019 abortion ban, and the dominance of men in decision making about women’s health care. An excerpt from one participant’s poem entitled “Multifaceted” read:

We feel that we have to play down the bit about abortion.

You felt you had to play it down,

a wee bit.

And you kind of feel,

A wee bit of shame.

Just to keep the peace,

and not to have any confrontation with anybody.

Step 3: Generating recommendations for policy and practice

Building on these activities and discussions, the participants then noted down recommendations for how policy and practice could improve health professionals’ knowledge on abortion care. We read the recommendations and clustered them into broad themes. For example, several recommendations emerged for developing care pathways for marginalised people, protecting spaces for abortion care providers, and introducing mandatory training on abortion for multi-professional groups.  

Discussion and conclusion

The workshop created a safe space for participants to share their experiences of abortion care in their personal and professional lives. The reanimating data exercise gave them tools to explore hidden messages in the quotes, examine their experiences in relation to the quote, and allowed me to explore my own assumptions about the standpoints of the participants. I took this opportunity to reflect on my role as a researcher, learner, and advocate for abortion care. The recommendations that we arrived at proposed practical, structural, and ideological changes to the framing of abortion in Northern Ireland. This suggests that nurses, midwives, and other health professionals can be powerful advocates for change when given the time, tools, and spaces to do so. To conclude, using creativity in co-production sessions can help participants engage in difficult topics, facilitate a safe space for honest and reflective discussion and inspire ideas for change.

Tips on facilitating co-production workshops with research participants

  1. Apply for funding to be able to reimburse participants for their time. I offered my participants £50 Love2Shop vouchers for a half day workshop (8.30-1.30pm) as well as coffee and lunch.
  2. Show a video or presentation on creative methods to give participants the tools and inspiration to make something of their own. I showed my participants this video on art activism from the OU, Array Collective and Alliance for Choice.
  3. Allow time for participants to share their expectations and engage in a warmup activity to get everyone comfortable with speaking up and using the creative materials at hand.
  4. Secure a private space, free of interference or disruption. I used an Open University Belfast conference room which was spacious and in an accessible location.
  5. Consider what you define as ‘data’ in the co-creation sessions. You may like to keep notes of the ideas and discussion that participants engage in. I decided not to voice record to maintain the privacy of my participants, but others may wish to do so.
  6. Ensure that co-production workshops plans have been reviewed by research ethics committee, and that participants give informed consent for their data to be used in research outputs like this one.
  7. Break up the sessions with a coffee or lunch break to allow participants time to rest and re-charge between sessions.

Feel free to contact me with any questions

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