Addressing psychosis stigma in urban Pakistan through participatory forum theatre: A pilot implementation study

Stigma remains a major barrier to treatment and recovery for individuals with psychosis, particularly in low- and middle-income countries (LMICs) like Pakistan, where access to mental health services is limited and cultural perceptions of mental illness are often shaped by supernatural beliefs. This pilot study employed Forum Theatre, a participatory, arts-based method rooted in Augusto Boal's Theatre of the Oppressed (TO), to engage communities and reduce psychosis-related stigma through co-created performance and dialogue. The intervention was co-produced with individuals with lived experience of psychosis, caregivers, performers, and TO experts.

Using a mixed-methods design and guided by the Standards for Reporting Implementation Studies (StaRI) framework, the study evaluated the feasibility and acceptability of Forum Theatre to address psychosis related stigma in urban Pakistan. Phase 1 involved participatory workshops to co-develop a script to be performed to community audiences. Phase 2 included public performances followed by audience interaction. Data were collected via semi-structured interviews, audience intercept "vox pops" and pre/post-performance stigma questionnaires (CAMI-12 and KAP) at three time points.

Overall, the intervention was well-received, with high retention (75 % workshops; 70.5 % follow-up). Quantitative findings showed an increase in psychosis knowledge, though no statistically significant change in stigma scores. Thematic analysis identified eight key themes, from positive impact of workshop participation to calls for expansion, highlighting logistical barriers and power dynamics as areas for further review.

Forum Theatre shows potential as a feasible and culturally relevant approach to address stigma in LMICs. Further research with validated measures and wider recruitment is warranted to assess its broader impact and sustainability.