Nurse Researcher Designs Community-Based Farm Theater Dinners to Spark Conversations About Occupational Safety and Health

By Elizabeth Adams

Third-generation farmer Marjorie Hunter never fretted about sunscreen or covered up with long sleeves while picking blueberries or moving Angus beef cattle on her 240 acres of farmland. 

Then her primary physician pointed out an irregular spot on her skin, which ended up testing positive for carcinoma. She learned the diagnosis was not uncommon in her farming community — many other farmers had received a diagnosis of skin cancer. Now Hunter makes sure her husband, children and stepchildren are all wearing long sleeves while working long hours in the middle of the day.

Skin cancer, the affects of aging and dementia, farming equipment injuries, heat exhaustion and depression are a few of the real health and safety risks for workers on Kentucky's 80,000 farms. As an actor in her local Farm Theatre Dinner last March, Hunter portrayed safety and health scenarios affecting members of her East Tennessee farming community. The play sparked conversation about real threats and risks on the farm, empowering farmers to incorporate safer practices and prevention in their day-to-day work.

“Our farming community is a fairly tight-knit community of people who are always helping each other,” Hunter said. “It’s just being aware of what’s going on in your surroundings.”

Farm Theater Dinners entertain Kentucky and Tennessee farmers with a meal and a farm-friendly theater performance embedded with important health and safety messages. But more than just a date night off the farm, these casual events are also influencing behaviors, with results of a study showing that farmers are thinking more about occupational safety and implementing precautions as a result of attending the forum-style dinners.

Organized by researchers in the University of Kentucky College of Nursing, the Farm Theater Dinners feature a 10-minute play performed by local volunteer actors. The scripts are based on interviews and stories from real Kentucky and Tennessee farmers. The plays also contain implicit messages about occupational safety and health risks specific to the farming profession. While enjoying a collegial atmosphere and a night off the farm, farmers are presented with realistic safety and health topics on the farm, which they discuss as a group at the conclusion of the performance. 

Deborah Reed, a professor in the UK College of Nursing, designed the Farm Theater Dinner intervention with the goal of getting more farmers to think about occupational health, safety and disease prevention on the farm. Raised on a Kentucky farm 15 miles outside of Lexington, Reed understands farmers’ attitudes toward traditional forms of occupational safety education. She has conducted community-based research on Kentucky’s farms for more than 25 years. Her research has shown farmers aren’t persuaded by lectures and pamphlets and don’t have time in their demanding work schedule to attend educational meetings.

“What we are trying to do with these plays is empower the local community to change their work behaviors in a way that’s acceptable within the community,” Reed said. 

Farming is one of the most dangerous jobs in America. Equipment, environmental hazards, stress, dangerous equipment and constant physical labor contribute to work-related safety and health risks in farming. An aging workforce, farmers suffer from the highest rates of occupational injury and fatality in people 50 and older.

By nature, the farming profession presents a number of ergonomic risk factors, with prolonged periods of pushing, pulling, lifting and carrying, which increase the risks of musculoskeletal injuries. One in 10 farmers have undergone an amputation. Farmers are regularly exposed to air contaminants, such as manure and fertilizers, which can result in respiratory distress or respiratory illness. Farmers are also more likely than the average person to develop melanoma because of their frequent sun exposure.

In addition to the physical risks on farms, Reed said farmers suffer from psychological and emotional stress related to pressures of competing and producing in competitive marketplaces. The modern farmer receives public scrutiny for production practices and must meet government standards. The labor-intensive and deadline-driven nature of the modern farming industry has led to widespread mental and emotional instability in farmers. The agriculture industry leads the nation in occupational suicide.

Reed’s research attempts to inform farmers and influence their thought processes about health and safety through methods and tactics that they find acceptable. With her farming background, Reed knew farmers have historically relied on storytelling to pass down the practices and knowledge of their trade to the next generation. She harnessed this tradition in the farming community to develop the reader’s theater component of the intervention. Reader’s theater is an acting method that involves a casual but expressive reading of the script with minimal preparation.

The dinners are advertised at farm community events, markets and association conferences. Reed has hosted dinners in Casey and Russell counties and Bowling Green, Kentucky, and in Sullivan and Cooke counties in Tennessee.

The post-performance discussion phase of the intervention prompts farmers to propose ways to overcome heath and safety topics addressed in the play. Farmers come up with their own solutions, such as using walking sticks to prevent falls on the farm or taking a vacation to escape the daily pressure of running a farming operation. Other measures to prevent accidents included take a nap to prevent fatigue and wearing a rubber wedding ring to avoid a finger getting caught in equipment.

“Farmers are probably the best group for solving their own problems,” Reed said.

Reed has examined the effectiveness of the intervention by collecting and analyzing post-intervention questionnaires. A follow-up questionnaire disseminated two weeks after the intervention suggests farmers continue to contemplate and adopt safety measures after the intervention.

Hunter said participating in the Farm Theater Dinner has changed how she and her husband think and talk about safety on the farm. Since the event, they have stopped work to review safety practices and observe safety precautions. She said the intervention has encouraged her to emphasize farm safety to her children and grandchildren, who are fourth- and fifth-generation farmers.