"Making it personal": ideology, the arts, and shifting registers in health promotion

Arts-based approaches to promoting health in sub-Saharan Africa: a scoping review

Introduction

Arts-based approaches to health promotion have been used widely across sub-Saharan Africa (SSA), particularly in public health responses to HIV/AIDS. Such approaches draw on deep-rooted historical traditions of indigenous groups in combination with imported traditions which emerged from colonial engagement. To date, no review has sought to map the locations, health issues, art forms and methods documented by researchers using arts-based approaches in SSA.

Methods

Using scoping review methodology, 11 databases spanning biomedicine, arts and humanities and social sciences were searched. Researchers screened search results for papers using predefined criteria. Papers included in the review were read and summarised using a standardised proforma. Descriptive statistics were produced to characterise the location of the studies, art forms used or discussed, and the health issues addressed, and to determine how best to summarise the literature identified.

Results

Searches identified a total of 59 794 records, which reduced to 119 after screening. We identified literature representing 30 (62.5%) of the 48 countries in the SSA region. The papers covered 16 health issues. The majority (84.9%) focused on HIV/AIDS-related work, with Ebola (5.0%) and malaria (3.3%) also receiving attention. Most studies used a single art form (79.0%), but a significant number deployed multiple forms (21.0%). Theatre-based approaches were most common (43.7%), followed by music and song (22.6%), visual arts (other) (9.2%), storytelling (7.6%) and film (5.0%).

Conclusions

Arts-based approaches have been widely deployed in health promotion in SSA, particularly in response to HIV/AIDS. Historically and as evidenced by this review, arts-based approaches have provided a platform to facilitate enquiry, achieved significant reach and in some instances supported demonstrable health-related change. Challenges relating to content, power relations and evaluation have been reported. Future research should focus on broadening application to other conditions, such as non-communicable diseases, and on addressing challenges raised in research to date.

Health Promotion Practices and Michel Foucault: A Scoping Review

OBJECTIVE

To analyze Health Promotion (HP) practices in different settings worldwide, presented in studies that employed the Foucauldian framework.

DATA SOURCE

Scoping review performed on LILACS, MEDLINE, IBECS, BDENF, SciELO, CINAHL, Embase, Web of Science, and Scopus databases.

STUDY INCLUSION AND EXCLUSION CRITERIA

We included original articles, review articles, reflection articles, and case studies published in English, Portuguese, and Spanish, which addressed HP practices, analyzed using the Foucauldian framework.

DATA SYNTHESIS

In the numerical synthesis, the characteristics of the included studies were described: number of studies, types of method, year of publication, characteristics of the study population, origin countries, and the HP practices addressed in the articles. The thematic synthesis was organized according to the nature of the HP practices presented and the Foucauldian analysis matrix used.

RESULTS

The review covered 34 studies, published between 2006 and 2019, whose analysis resulted in 2 thematic synthesis: 1) HP as a biopolitical strategy in the neoliberal context; 2) HP as an expression of resistance and counter-conduct, presenting tensions, struggles, and power games.

CONCLUSION

The field of HP mostly consists of governmentality practices that reinforce the neoliberal health perspective. Some practices show resistance and counter-conduct in the face of governmentality practices, which explains the power relationships in the field of HP.

Co-locating art and health: engaging civil society to create an enabling environment to respond to HIV in Indonesia

Background This paper will report on the successful co-location of a community-based arts and sexual health project that aimed to engage, educate and create testing, treatment and care pathways at a co-located mobile sexual health clinic and community-controlled art gallery in Yogyakarta, Indonesia.

METHODS

Mixed methods were used to evaluate the project, including a visitor (n = 1181) and artist (n = 85) log book, a convenience audience survey (n = 231), and qualitative semi-structured interviews (n = 13) with artists and audience to explore the effect of arts-based activities on access to sexual health information and services, and stigma and discrimination.

RESULTS

In total, 85 artists curated five separate exhibitions that were attended by 1181 people, of which 62% were aged ≤24 years. Gallery attendance improved awareness and participatory and interactive engagement with sexual health information through a medium described as interesting, fun, cool, and unique. The co-located clinic facilitated informal pathways to sexual health services, including HIV/AIDS testing, treatment, and care. Importantly, the project created shared understandings and empathy that challenged stereotypes and myths, reducing stigmatising beliefs and practices.

CONCLUSIONS

Arts-based programs are transformative and can be effectively implemented, replicated and scaled up in low-resource settings to create awareness and initiate for HIV prevention, testing, treatment, and care. Art-based health programs engages people in their communities, mobilises civil society, builds enabling environments to reduce stigma and discrimination and improves access to testing and prevention; essential features needed to end AIDS in Indonesia (and the Southeast Asia region) while improving the lives of those most vulnerable to infection.

A Cardiology Exhibit at a Science Museum, Viewed as Speech Acts in Sequence

An exhibit about cardiology at a science museum is an elaborate form of health communication, with messaging happening across text, pictures, models, and videos. This qualitative case study uses concepts of speech act sequencing and interpellation to explain a series of multimodal exhibits about cardiovascular health. Health exhibits are described as verbal and audiovisual arguments combining assertions of information; directives to change behavior, and designations of risk candidacy-or sequences of assertive, directive, and declarative speech acts. Visitors are targeted as heart disease candidates according to their risk factors, such as hypertension, overweight, and inactivity. Communication research focused on health exhibits is rare, and this article presents a new way of looking at them that contributes to the current discussions about controlling language. Implications for health communication scholars and multimedia message designers are explored.

Affect and the "Really Real": The Politics of HIV/AIDS Framing in South African Theater

Funding in South Africa privileges HIV prevention campaigns underpinned by individual behavior change goals, despite over two decades of intervention but little reduction in national HIV prevalence. In response, civil society has begun calling for innovative interventions and ways of speaking about the epidemic. Employing framing theory, I analyze differences in how HIV/AIDS is characterized in public media and interrogate the knowledge politics underpinning a group of artists' emerging attention to the nexus of affect, intersubjectivity, and epidemics within performance. I suggest this focus challenges but also complements dominant HIV intervention models by destabilizing common content, relations of power, and hierarchies of knowledge that shape normative health discourse and practice. Simultaneously, such performances reveal deep disparities between the neoliberal principles undergirding most global public health ideology, South Africa's current political economy of HIV intervention, and the dynamic concerns of its HIV-affected constituents.