Playing It Differently: Using Performance-Based Interviewing to Engage Children in Healthcare Research

Capturing children's healthcare experiences remains inherently challenging. Traditional interview approaches are often poorly suited to younger populations and their developmental needs, limiting opportunities for them to meaningfully express their perspectives. This can result in children's voices being underrepresented in research and healthcare. To address this concern, we trialled a novel, child-centred methodology, using professional performers trained in engaging hospitalised children ('Captain Starlight'). The approach was implemented within a national paediatric patient-reported experience measure (pPREM) development project, which served as a case study for the application.

This study examines a child-centred data collection methodology and documents the process, benefits and challenges of a creative interviewing approach designed to engage children in qualitative research. The methodology was implemented during a larger project to co-design a pPREM, which serves as context for this case study. Professional performers ('Captain Starlights', herein 'Captains'), trained in child-centred communication, conducted semi-structured interviews while remaining in character as visitors from another planet who are unfamiliar with hospitals. This mythology aimed to position children as the 'experts,' encouraging them to explain what matters most during hospital experiences. Interviews incorporated play, storytelling, and age-appropriate activities to facilitate engagement. To understand the usefulness of this approach, we conducted follow-up qualitative interviews with Captains and used reflexive thematic analysis to explore how the method shaped interactions and data collection.

The creative interviewing approach enabled flexible, child-led interactions, with Captains adapting their communication styles to suit the child's age, personality, and context. The use of play and character-driven narrative helped overcome children's unfamiliarity with providing formal feedback, fostering openness and sustained engagement. However, challenges included balancing character immersion with data collection, navigating consent processes, and maintaining clarity around the interviewer's role.

This novel interviewing methodology demonstrates how playful, imaginative approaches can facilitate meaningful engagement with children in healthcare research, enabling richer insights into their experiences. The approach created a safe and empowering environment in which children could articulate their needs and preferences. It forms part of a broader multi-stage project to co-develop a paediatric PREM, with this context allowing the methodology to be successfully piloted as a transferable approach for engaging children in healthcare research.

While this methodological study did not directly involve patients in its evaluation, it is embedded within a larger co-design project centred on capturing children's voices to develop a paediatric patient-reported experience measure (pPREM). JN served as the patient and community representative for the pPREM project and this study, contributing a lived-experience lens to the research and providing qualitative methodological oversight to support patient-centred study design, analysis, and interpretation.