Diagnostic Role Play (DRP) is a qualitative research method to help programs learn more about behaviors and develop effective strategies that promote and support behaviors to improve health. As its name implies, DRP combines the process of diagnosis, or examination and analysis, with role play. It is a simulation where participants act out typical attitudes and behaviors of individuals in a given situation.

Researchers and program managers can use DRP to help them:

• examine behaviors, spoken words and interactions,
• understand why people behave as they do and
• identify feasible ways to help people move towards behaviors that are desirable for their health.

Research using DRP helps provide more in-depth understanding about issues emerging from a review of information and other formative research such as in-depth interviews.

DRP has a number of advantages. It allows researchers to see real-life situations they may not otherwise be able to see. For example, what happens in the home when a pregnant woman or child has a medical emergency (who gets involved, what do various people say, who decides what to do). DRP illustrates behaviors, including social interactions and the way people communicate. Often these behaviors seem so normal to people, they will not talk about them. Because some behaviors are sensitive, people may be more willing to act them out and discuss them when they are not portraying themselves. DRP gives participants an opportunity to discuss issues and have input into research findings and their program implications.

Although the role plays can be very entertaining, the intention is to learn more from the participant groups in order to design an effective program intervention.

Three groups are essential in a DRP:

• Players
• Audience members
• Research team

Participants: There should be 10 to 15 participants in each role play. Three to five of the participants can be players “on stage.” The other 10 to 12 audience members must watch closely and discuss the performance with the players, afterwards. It is through discussion that many of the issues and findings will emerge. DRP will work best if the number of participants is limited so that everyone has an opportunity to discuss the performance and the issues in-depth.

Research Team: The research team consists of a facilitator and two note-takers. The facilitator is in charge of orienting participants and leading the discussion after the performance.

1. Answer the following questions

• What are the research objectives?
• What issues were raised during the in-depth interviews?
• What are the important socio-cultural roles, relationships and norms related to the topic?
• What themes would be good to try?

2. Select themes

• Consider several scenarios concerning concepts or behaviors that earlier research indicates are important but which are not yet completely clear to the researchers.

3. Decide what participant groups will be needed

• Criteria for selection are simply representative people from the participant groups.
• Do not use professional actors. It is best to use community members.

4. Plan the logistics

• Each group will need one and a half to two hours to perform and discuss at least two basic scenarios on a topic. If four role play groups can be arranged for each day, a maximum of two to four topics per day can be selected. Make arrangements for a location that can be private and where participants will feel comfortable. Make arrangements with local people to recruit participants who meet your criteria.

5. Develop scenarios for participants to act out

• Develop your topics into fuller scenarios with one or more locations, certain types of characters and certain situations.

Recommendations from Malawi

• It is best to use DRP relatively early in the formative research process—after in-depth interviews reveal enough about the issues to plan interesting drama scenarios. It is possible that, if used at this point in the learning process, DRP may reduce the number of additional in-depth interviews or focus group discussions needed.
• However, if DRP is done later in the process (as in Malawi), DRP may provide ideas for solutions to participant-identified problems and can help inform subsequent research.
• DRP is best for learning about situations that cannot be easily observed, such as what happens when there is an obstetrical emergency or when a child suddenly develops paralysis. It may be useful for situations that are not easily discussed, such as what happens when a girl and boy start to date.
• Players in the DRP came up with innovative solutions when given clear instructions and direction. In contrast, participants of in-depth interviews and group discussions did not discuss realistic solutions. Acting out an idea seemed to help participants think concretely about the steps.

Suggestions on Getting Useful Results

• The facilitator is key to the method’s effectiveness and must have a good understanding of both the method and the technical and social issues. The facilitator should speak the local dialect fluently.
• The facilitator needs to encourage an informal atmosphere and open discussion. One way is to begin with ice-breakers or games and forego formal introductions.
• The facilitator needs to emphasize that there is no “right” or “wrong” answer to the scenes. Sometimes it is difficult to get past “ideal answers” that participants held. People would act and answer according to ideals rather than their own reality. (For example, boys talked about “boys who go to school and do not have a girlfriend or have sex”. Those same boys, however, manage to do both!)
• The players should start by introducing their characters. One of the players can act as narrator and lay out the scenes for the audience.
• Players need to be encouraged to add local color and actions that show normal behavior and conversations. Too many of the first role plays were just animated conversations about the given topic. The facilitator or note-taker should work with players as they plan their role-plays and actions (especially when children are the players).
• Initially, participants were somewhat intimidated by the presence of members of the opposite sex and by videotaping. In later role-plays the groups were single-sex.
• It worked well to have at least two scenes in each role play lasting a total of 10 to 15 minutes. This was enough time for players to act out the main idea of the scene and fill in all of the actions before and after but not so long that the audience got tired or restless.
• Suggest that audience members question each player in character. At the end of the drama, invite the audience to ask players questions on a “hot seat” about how they felt, what they thought about what they did or said things during the role play. They should answer in character.
• Introduce a concluding activity. Because poetry is a popular art form in Mangochi, the facilitator asked one or more volunteers to prepare poems that summarized the drama and discussions after the discussions finished. About five minutes was needed for participants to prepare poems. This worked very well in Malawi to conclude the sessions (in many cases, several participants contributed poems), but is not appropriate everywhere. A song may be better in other settings (or this finale may be omitted).
• Watch for visual data. A comparative advantage of DRP is that people act out normal situations that can visually depict relationships between characters. Because the players spoke more than acted, the role-plays in the field test did not elicit much visual data on relationships. Other situations could gather more visual data.

DRP shows promise as a qualitative research method to collect information not easily obtainable by other research methods. Information can be collected on popular expressions and metaphors, social relationships as well as participant-generated solutions to problems. Used early in the formative research process, it may reduce the number of additional interviews or group discussions needed.