INTRODUCTION

Communication of scientific results beyond the academy is an emerging field of research (Lafrenière, Menuz, Hurlimann, & Godard, 2013). Traditional dissemination formats ─ conferences, scientific articles, book chapters ─ are effective in presenting results to an academic or subject matter expert audience, but less accessible to wider audiences (Spagnol, Tagami, Bagattini-De-Siquiera, & Li, 2019). This led to the exploration of innovative approaches to knowledge transfer and dissemination of scientific results (Houston, Allisson, & Sussman, 2011; Scott, Brett-Maclean, Archibald, & Hartling, 2013), generating a proliferation of studies on dissemination strategies, a phase of the research process that historically received little attention in the methodological literature (Brannen, 2002).

In this scenario, artistic formats begin to be used to communicate research results, making them more accessible and applicable (Bergum & Godkin, 2008), mobilising the emotion and action of audiences7,8, improving the understanding of complex ideas, and helping to build closer relationships with and between research participants (Spagnol, 2019; Mahtani, 2016; Bartlett, 2015, Archibald, 2014) (Archibald, Caine, & Scott, 2014; Spagnol et al., 2019).

The concept of Arts-Based Research is grounded in the tradition of qualitative social science and encompasses this new approach to disseminating results, also known as ABKT, Arts-Based Knowledge Translation (Parsons & Boydell, 2012), referring to the use of artistic formats to generate, interpret, and also communicate and/or transfer knowledge, at any stage of the research process (Knowles & Cole, 2008).

In the health field, most of the effort around knowledge transfer and dissemination of results has focused on expanding the knowledge of health professionals through the development of clinical practice guidelines, decision-making guidelines or other educational materials (Knowles & Cole, 2008). However, emerging evidence suggests that citizen-driven knowledge transfer initiatives, especially those related to health/disease processes, also play an important role in decision-making, reducing health resource use or improving health outcomes (Reid, Hartling, & Ali, 2017; Slater, Buller, Waters, Archibeque, & Leblanc, 2003).

Other aspects that have led to the use of alternative formats for dissemination of results are: the unprecedented demand for reliable and evidence-based health information, the rapid increase in the number of social-health research studies, and the easy access to research via the Internet (Houston et al., 2011; Scott et al., 2013). In this regard, the World Health Organisation (WHO, 2011, p. 39) also calls for work on improving the dissemination of information so that it "makes sense to the final recipients, while empowering the community to interpret and use this information".

In the field of health, arts-based knowledge transfer has generated concrete experiences of storytelling (Mahtani, 2016), illustrations (Archibald, Caine, & Scott, 2017; Reid et al., 2017), e-books (Archibald, Hartling, Ali, Caine, & Scott, 2018), films and documentaries (Bartlett, 2015), installations (Lapum et al., 2014), dance performances (Spagnol et al., 2019) and theatre ( ; Schochet, 2013) (Ahmed et al., 2015) or textile banners (Bartlett, 2015).

In qualitative research, the use of the arts represents an opportunity to enhance social participation, enrich communication, increase applicability (Boydell, Gladstone, Volpe, Allemang, & Stasiulis, 2012) and deeply engage people, prioritising the affective domain of learning (engagement, attitude or emotion) over the cognitive (understanding, comprehension or application) (Friedman, 2013) and favouring dialogue and shared storytelling (Bartlett, 2015).

Potential limitations of applying arts-based research to the dissemination of scientific results include the management of the creative process and the personal researcher-artist relationship (Bartlett, 2015), the risk of distortion, simplification (Barone & Eisner, 2012) or creation of new meanings (Bartlett, 2015), potential conflicts related to power dynamics and issues of representation (Bartlett, 2015) and little systematic evaluation of its impact (Mahtani, 2016; ) (Boydell et al., 2012). To counteract these risks, an active and responsible reflection process should be adopted, based on selecting appropriate formats and artistic teams (Bartlett, 2015).

Building on previous reflections on arts-based research, the documentary film "Evictions and Health" was made with the aim of developing and applying an innovative knowledge transfer strategy, using audiovisual language to disseminate and enhance the applicability and awareness of the results of qualitative research on eviction processes and health.

OBJETIVES

The aim of this article is to describe the process of transferring knowledge from research to documentary, proposing a methodological model that can be replicated in qualitative research in the field of social and health care.

METHODOLODY

For the production of the documentary "Evictions and Health", an arts-based knowledge transfer (ABKT) methodology was followed, aimed at translating qualitative results into an audiovisual format. It was based on the adaptation of the strategies described byLincoln and Guba (1985) on the replication of the rigour of qualitative studies in the process of transforming scientific results into artistic ones.

The baseline research was a qualitative study at regional level (Andalusia) on the self-perceived health of people in eviction processes, carried out between January 2014 and December 2015, and based on semi-structured individual interviews and triangular groups with 58 people in eviction processes, and 6 focus and triangular groups with activist platforms, in the 8 provinces of Andalusia.

For the dissemination of the results, an audiovisual format was chosen to gather first-person experiences. A descriptive documentary of approximately 22 minutes in length was produced. The recording and editing of the documentary was carried out once the research had been completed.

The people involved in the elaboration and validation of the documentary were the research team, the production team - an external production company was contracted, some of the people participating in the research and a group of people with expertise in social determinants of health and communication, external to the research.

To ensure internal validity in the artistic transformation process, the following methodological phases were followed:

Phase 1. Definition of the objectives of the documentary: to disseminate the results of the research 'Eviction processes and health' beyond the academic sphere; to improve the applicability of the results; to create a didactic and awareness-raising tool on the situation of people undergoing eviction processes.

Phase 2. Identification of the documentary's target audience: people in eviction processes, citizen platforms, health professionals, political agents and citizens in general.

Participants in Phase 1 and 2: members of the research team.

Phase 3. Selection of the protagonists: The selection of the protagonists of the documentary was made from among the participants in the qualitative research who had indicated their availability for an audiovisual recording. Audiovisual, narrative and communication skills criteria were also taken into account. Finally, the profiles of the four people who participated in the documentary reproduced the selection criteria in the baseline research with regard to gender, but not with regard to age. (Table 1). An informed consent process was carried out.

C: Capital/ NC: Not capital

Source: own elaboration

A group of 4 members of two citizen platforms participating in the research and 4 members of the research team were also filmed for the documentary.

Participants: research and production team

Phase 4. Creation of the audiovisual script: The script used in the individual interviews, triangular and focus groups of the research was adapted into a documentary script format. The research team and production team validated their adaptation.

Participants: Research team, management/production team and people involved in the documentary.

Phase 5. Recording of the documentary: During the recording of the documentary, special attention was paid to the preparation time for the interview and recording with the participants. The contact with the people in the eviction process and their families was key to reduce as much as possible the influence that the presence of the camera could have on the discourse of the interviewees. There were 6 days of filming, one day per participant and group. The participants chose the scenarios. Those in the process of eviction chose their homes, which were also the locations for the qualitative research interviews.

Participants: the direction/production team and the participants in the documentary.

Phase 6. Post-production: In order to remain faithful to the results of the qualitative research, the following steps were followed: Content analysis of the audiovisual interviews and selection of the most representative content of the final results of the research; 2. Editing, including resources to reinforce and complete the results obtained in the research; and 3. Validation of the documentary through a validation process with different profiles (research team, participants in the documentary, group of 4 experts in social determinants of health and 3 experts in communication, external to the research team).

Dissemination strategy. A strategy was designed to distribute the documentary through different channels: face-to-face events (presentation days at a university and citizen platform headquarters in two provinces), presentation of the methodology followed in the documentary at national and international conferences, Internet (Youtube channel and social networks with a hashtag) and press release and sending the documentary to the media.

RESULTS

DISCUSSION

The description of the methodological model for the production of the documentary "Evictions and health", as well as its media coverage and use as a teaching tool in secondary and university education, highlighted the usefulness, advantages and limitations of the use of artistic formats for the transfer of knowledge in health, within the framework of ABKT (Parsons & Boydell, 2012).

The main limitations of the work were related to the characteristics of qualitative research, conducted in a specific geographical, socio-cultural and political context. Secondly, the design of the dissemination methodology was developed as a dynamic and adaptive process, which entailed the risk of limitations that were controlled through triangulation within the research team, as well as expert advice from outside the project. Thirdly, there were methodological limitations, mainly related to the difficulty of contacting people in the process of eviction who were not linked to citizen support platforms. It was only the latter who could be interviewed, which could have led to a selection bias in the basic research and, therefore, in the documentary. It should also be noted that the segmentation criteria of the research were replicated with regard to gender, but not with regard to age. Despite these limitations, an attempt was made to reproduce the heterogeneity criteria established in the baseline research with respect to educational level, profession and place of residence.

From this study, it was observed that the production and subsequent multi-channel distribution of the documentary "Evictions and Health" increased the visibility of the results of the baseline research, reaching multiple audiences, with the aim of fostering understanding and participation in society. In this sense, it showed the importance of including, as an integral part of any research project, strategies for dissemination and communication of the results that ensure the social, political and economic impact of the scientific results (Marin, 2017).

This aspect takes on special relevance if we refer to the socio-health field, in which it is considered of great importance that research staff acquire greater commitment and responsibility to ensure that society in general can access and understand the results of science (Emanuel, Wendler, & Grady, 2000).

In the dissemination of the documentary "Evictions and health", the use of traditional media -press, radio and television-, social networks -Youtube and Twitter- and academic media -conferences and scientific articles- was particularly relevant, as well as the use of video as a didactic tool (Kuhn, Zlatkin-Troitschanskaia, Brückner, & Saas, 2018) on qualitative research, as well as a potential instrument for raising awareness of the situation of people in the process of eviction.

The methodological proposal contained in this article, with a clear definition of the role of the different actors - research team, artistic/production team and people participating in the research - in each of the phases, provided a model for the management of the creative process between the research staff and the artistic team, given the lack of discussion in this regard highlighted by some authors (Bartlett, 2015). The methodological model helped to reduce the possible tensions generated during the artistic creation process between the research team and the artistic team (Filnley, 2008). In this way, the application of the model to the process of making the documentary "Evictions and health" allowed the debates that arose during the collaborative creative process to be resolved through decision-making by consensus.

The balance between verbal testimonies and audiovisual resources was one of the most debated issues, reaching the conclusion and decision to value the potential of images to provide content, thus reinforcing the testimonies collected and reflecting nuances that could not be included through spoken discourse (images of homes, professional activities, experiences in demonstrations or interaction between people from the citizens' platforms). Along the same lines, the literature supports that the use of images can improve and broaden the understanding of social phenomena independently of the text, reinforcing empathy with the situations reflected (Bartlett, 2015).

The constant review and validation, both by the research team and the people involved in the documentary, sought to ensure that the most relevant results of the baseline research were collected and faithfully reflected (Barone & Eisner, 2012). The review process with the research participants was especially important to identify and reinforce relevant content that was not reflected in the documentary.

This work also opened up a process of reflection on the benefits of using artistic formats, as well as guidelines for selecting the best formats and artistic teams to collaborate with (Bartlett, 2015). It is important to consider the different modalities that can be useful in ABKT, grouped between narrative, audiovisual and performative, and ranging in different levels of description and interpretation. Each modality has its advantages and disadvantages, so it is essential to understand the options that exist and to choose the most appropriate one for the messages to be conveyed and the audience to be reached. In this case, the choice of the documentary mode was based on the possibility it offered to reflect the problem realistically and without embellishment, understanding that real testimonies were the key to raising awareness in society, thus being able to influence change.

In addition to the methodological rigour of this work, ethical responsibility was considered from the outset as one of the priorities when involving people in the process of eviction, trying to constantly assess and minimise the ethical risks that could arise during the process.

Informed consent, a basic ethical and legal requirement, was seen as an open and ongoing process, based on trust and motivation, and validated through the sustained involvement of the participants. Respect for the people involved in this work was not limited to informing about the study and asking permission for the recording. Throughout the process, the possibility of changing one's mind about participating in the film was offered at a time prior to its release and dissemination, explaining the limit of the possibility of withdrawing participation once the film had been disseminated.

Another issue that was taken into consideration was how participation in the video could have given rise to discriminatory or stigmatising treatment, given the risk that some sectors of society might make unfair judgements about the situation and conditions of people in eviction proceedings. As AdelaCortina (2017) rightly points out, we live in an aporophobic society, which singles out and blames people who do not have certain resources. To avoid increasing the vulnerability or stigmatisation of individuals or groups, the team tried to convey a respectful and non-discriminatory image of the work, socio-economic, family and personal situation of the participants, especially through the audiovisual resources and the recording of the focus group with the research team, which focused on these aspects.

At the same time, the team reflected on the possibility of using other audiovisual formats for transmitting results in future projects, such as, for example, the use of a theatrical performance or animation, with the aim of preserving the anonymity of the narratives and avoiding potential risks of exposure to discriminatory dynamics.

In the same line of research ethics, as well as communication, the need to return the results to the participants is integrated (Emanuel et al., 2000), for which the research team used different mechanisms, such as delivery of reports, review of the documentary, information about its publication on Youtube, invitation to the premiere of the documentary as well as to other sessions of presentation of the results of the study and the documentary with the citizen platforms.

CONCLUSIONS

The results confirmed the need to use artistic formats to increase the reach and visibility of scientific results and to reach multiple audiences not only effectively, but also affectively. To this end, it is recommended to apply methodological models of knowledge transfer such as the one described in this article, which guarantee internal validity, credibility and reliability. The proposed model provided clues to resolve methodological doubts, as well as to address potential limitations and risks of using ABKT. During the process of artistic transformation, beyond the methodological uncertainties, it was ethics that took centre stage, raising the need for continuous dialogue and reflection in the research team to minimise potential risks and ensure the well-being of the participants.

REFERENCES