Arts, public health and the National Arts and Health Framework: a lexicon for health professionals

Lived Experience Performance to Reduce Stigma, Enhance Understanding of Gambling Harm and Change Attitudes and Behaviours of Professionals and Community Members

Gamblers and their family members or friends (affected others) can experience stigma and shame due to gambling which can result in a reluctance to seek timely support. However, gamblers and affected others access intersecting health services and talk to friends or family, thereby providing opportunities for early intervention. Three sides of the coin is a group of storytellers with lived experience of gambling harm who use dramatic performance to share personal stories to enhance the understanding of gambling-related harm in allied professions and the broader community. They do this to encourage attitude and behaviour change so that gamblers and affected others receive empathy and support during encounters with these groups. A mixed-methods study was used to explore whether these performances were successful in increasing understanding and changing attitudes and behaviour of allied professionals and the community in the short and longer-term. Data collected immediately post-performance revealed that performances increased understanding of gambling, and improved attitudes and behavioural intent of audience members in relation to gamblers and affected others. Professionals also reported an increased willingness and confidence to discuss gambling harm with clients. Follow-up data demonstrated potential longer-term impact, with respondents continuing to report more positive attitudes towards those affected by gambling harm and professionals being confident to explore gambling issues in their clients and provide appropriate referrals. These finding demonstrate that performance based on lived experience can be a powerful education tool, encouraging deep connection to the issue, resulting in a nuanced understanding and sustained attitudinal and behavioural change.

An Evidence-Based Framework for the Use of Arts and Culture in Public Health

OBJECTIVES

In recent years, increasing efforts have been made to apply arts- and culture-based strategies to public health concerns. Accumulating studies point to the value of these strategies for addressing social determinants of health in ways that center communities, cultures, and lived experiences. However, this work has lacked a common framework to support application and advancement. The objectives of this study were to examine knowledge, experience, and evidence related to the uses of arts and culture in public health in the United States and to develop a pilot version of an evidence-based framework to guide cross-sector development and research.

METHODS

Using a convergent mixed-methods design with sequential elements, this study drew upon findings from a national field survey, seven focus groups, eight structured working-group dialogues, and a five-day structured dialogue and writing process with 12 interdisciplinary thought leaders. Data were integrated to develop a pilot evidence-based framework.

RESULTS

The study identified six broad ways in which arts and culture can be used in public health and 59 specific outcomes that can be addressed through arts and cultural strategies. The framework identifies evidence supporting the effects of arts and culture on each outcome, along with mechanisms that may mediate or moderate these effects.

CONCLUSION

The pilot framework clearly links arts and culture practices with public health outcomes. In doing so, it provides both a resource for current practice and a model for the continued development of interdisciplinary tools that support health researchers and practitioners in utilizing arts and culture resources to advance community health and health equity.

Ethical questioning in arts and health-based research: propositions and reflections

Ethical questioning is a framework for considering the ethical implications and practices in research and is used as a tool for thinking about the connections between art and health. It enables researchers and practitioners to gain a deeper understanding of the emotional dimensions in the field of art and health. In this paper, we propose that ethical questioning, grounded in the principles of ethics of care, can foster a more reflexive and holistic approach to understanding the concept of well-being. We also propose that adopting ethical questioning as a methodology, which requires intentional self-reflection and recognition of positionality, can expose and challenge conventional knowledge hierarchies, resulting in more ethical research outcomes and relationships between researchers and participants. Ultimately, our hypothesis proposes that ethical questioning holds the potential to offer an actionable practice that demonstrates ethics of care.

Online gallery facilitated art activities for people with dementia during the COVID-19 pandemic and beyond: A narrative review

Art activities for people with dementia have a range of therapeutic benefits including psychosocial wellbeing and enhanced quality of life. Successful art programs promote social engagement, are inclusive and empowering, and enable opportunity for people with dementia to express themselves verbally and non-verbally. The COVID-19 pandemic and associated social distancing precautions have impacted the capacity of art galleries and museums to deliver in-person programs. However, they have also provided a new opportunity. This paper explores the potential benefits, challenges, and future directions for research relating to the online delivery of gallery-facilitated art activities for people with dementia. The evidence revealed that increased digitisation of programs increased access for participants, however, the majority of the research was published before the pandemic. Nevertheless, COVID-19 has necessitated many museums and galleries to engage with people with dementia online. Future research is needed to improve the usability of online delivery platforms and a comparison of online and onsite delivery is recommended, particularly to evaluate benefits to people living in rural and remote areas where access to museums and galleries may be limited.

Association between engagement in cultural activities and use of general practitioner consultations: 7-year follow-up of adults from the HUNT study, Norway

OBJECTIVE

Assess whether engagement in a range of cultural activities, both 'passive' and 'active' (ie, receptive and creative) participation, is associated with later demand for general practitioner (GP) consultations.

DESIGN

Longitudinal prospective cohort study.

SETTING

Data from the population-based the third Survey of Trøndelag Health Study (2006-2008) in Norway was linked to an administrative register including service information from all GP offices nationwide.

PARTICIPANTS

This study included 17 396 (54.6%) women and 14 451 (45.4%) men aged 30-79 years.

MAIN OUTCOME MEASURES

Multilevel negative binomial regression models assessed the relationship between cultural engagement and GP consultations, and reported as rate ratios.

RESULTS

A mean of 3.57 GP visits per patient was recorded during the 7 years of follow-up. Participation in creative activities and a combination of both receptive and creative activities was associated with lower number of GP consultation. Gender-specific analyses suggest that these effects were attributable to men. The rate ratio of GP consultations among men taking part in creative activities less than once, twice and more than twice (<9 times) per week is 0.90, 0.89 and 0.87 times lower, respectively, compared with non-participants. Whereas weekly frequency of receptive and creative activity engagement showed a 0.92, 0.87 and 0.83 times lower rate ratio among engaged men. The variety of activities shows a similar pattern and participation in creative activities lowers the rate ratio among men. Engagement in a wide range/variety of activities, compared with non-engagement, was associated with lower numbers of GP consultations in men, but not women.

CONCLUSIONS

Engagement in creative or combined receptive and creative cultural activities was associated with lower numbers of GP consultations among men. Thus, facilitating and promoting a culturally engaged lifestyle, particularly in men, may affect primary healthcare use. However, this study design gives no evidence of a causal relationship between cultural engagement and use of GP consultations.

Engagement with arts and culture activities in the Danish general population: Longitudinal associations with new onset or persistent depression and mental wellbeing

OBJECTIVES

International literature suggests that arts and culture activities may benefit mental health, however, such survey studies conducted in the Danish population are scarce. Further, studies have investigated the associated risk for incident depression, but not for persistent depression. The objective of the current prospective study was to assess associations of engagement in arts and culture activities with incident/persistent depression and also mental wellbeing among Danish adults in the general population.

DESIGN

Observational prospective study.

METHODS

Data stem from a Danish nationally representative panel study of 5000 adults (aged 15+ years) conducted in 2019 and 2020, which was linked to Danish register data. An exposure variable was constructed for frequency of attending concerts, theatres, museums, and cinemas. Validated scales were used to assess the presence of depression (PHQ-8) and levels of mental wellbeing (SWEMWBS). Binary logistic regression analyses were conducted to assess the risk of incident depression (among participants free of depression at baseline), as well as the risk of persistent depression (among participants with depression at baseline), while multinomial logistic regression was used to assess odds for moderate and high mental wellbeing (low as base outcome) while adjusting for baseline values.

RESULT

In terms of incident depression, quarterly engagement in arts and culture activities (compared to never) was associated with an OR of .43 (95%CI .23-.80), while 8 times or more was associated with an OR of .53 (.29-.97). In terms of persistent depression, quarterly engagement was associated with an OR of .30 (.10-.90), while 8 times per year or more was associated with an OR of .26 (.07-.92). Similar to the patterns for incident/persistent depression, associations with moderate mental wellbeing showed higher odds for quarterly engagement and 8 times per year or more. Quarterly engagement was also associated with higher odds for high mental wellbeing but did not reach statistical significance.

CONCLUSIONS

The results support the involvement of the cultural and creative sectors in health strategies. Mental health promotion initiatives as well as arts and culture sectors may encourage the general public to engage in arts and culture activities with frequencies of at least once per quarter.

Qualitative insights into the palliative care experience of a hospice-based sensory room

BACKGROUND

The use of multi-sensory rooms as a form of engagement with art in Palliative Care is largely unexplored.

METHOD

This practice-based report discusses a qualitative study exploring the experiences of hospice-based inpatients receiving end-of-life care and their carers who immersed themselves into a multi-sensory room.

RESULTS

Findings demonstrate that the room provided a safe space for reflection and reconnection that counteracted challenging times during their end of life. It fostered healing and wellbeing by alleviated suffering through respite and sharing of treasured memories with loved ones. Key considerations for future iterations are also discussed.

Facilitating the Voice of Adolescents in Hospitals Through Art: A Case Report

Adolescence can be a challenging time, but even more so when diagnosed with a serious or chronic illness. Starlight Children's Foundation established the Livewire program after recognizing the unique needs of adolescents in hospitals. This article describes our experience of implementing an art-based project within the Livewire program, designed to facilitate the voice of adolescents with a serious or chronic illness and their siblings. We invited young people across Australia to contribute their artwork which would be used as the design for a deck of playing cards. The final 54 cards were a creative reflection of the unique interests, personalities, and experiences of 45 young people. In this article, we also share the experiences of two young people who contributed to this project. We conclude with our learnings in delivering an art-based project for young people that is not presented directly as "therapy".

Engaging the Arts for Wellbeing in the United States of America: A Scoping Review

There is increasing interest today in how the arts contribute to individual and community wellbeing. This scoping review identified and examined ways in which the arts have been used to address wellbeing in communities in the United States. The review examined 44 publications, with combined study populations representing a total of 5,080 research participants, including marginalized populations. It identified the types of artistic practices and interventions being conducted, research methods, and outcomes measured. It highlights positive associations found across a broad spectrum of psychological, physical, and social outcomes, including improvements in self-esteem and identity formation, cognition, physical balance, and physical conditioning. It also reports negative outcomes of arts interventions that may be underreported. The study identifies the need for core outcomes sets and reporting guidelines for advancing evidence synthesis in this area.

The Value of Active Arts Engagement on Health and Well-Being of Older Adults: A Nation-Wide Participatory Study

An emerging body of research indicates that active arts engagement can enhance older adults' health and experienced well-being, but scientific evidence is still fragmented. There is a research gap in understanding arts engagement grounded in a multidimensional conceptualization of the value of health and well-being from older participants' perspectives. This Dutch nation-wide study aimed to explore the broader value of arts engagement on older people's perceived health and well-being in 18 participatory arts-based projects (dance, music, singing, theater, visual arts, video, and spoken word) for community-dwelling older adults and those living in long term care facilities. In this study, we followed a participatory design with narrative- and arts-based inquiry. We gathered micro-narratives from older people and their (in)formal caregivers (n = 470). The findings demonstrate that arts engagement, according to participants, resulted in (1) positive feelings, (2) personal and artistic growth, and (3) increased meaningful social interactions. This study concludes that art-based practices promote older people's experienced well-being and increase the quality of life of older people. This study emphasizes the intrinsic value of arts engagement and has implications for research and evaluation of arts engagement.

Association of engagement in cultural activities with cause-specific mortality determined through an eight-year follow up: The HUNT Study, Norway

Participation in cultural activities may protect against cause-specific mortality; however, there is limited knowledge regarding this association. The present study examines the association between participation in a range of receptive and creative cultural activities and risk of cardiovascular disease- and cancer-related mortality. We also examined whether participation in such activities and influence by gender have on this association. We followed 35,902 participants of the Nord-Trøndelag Health Study (HUNT3) of Cardiovascular-Disease and Cancer Mortality from 2006-08 to 2016. Cox proportional-hazards regression was used to estimate the risk of specific mortality based on baseline cultural participation. During the eight-year follow-up, there were 563 cardiovascular-disease- and 752 cancer-related deaths among the sample (292,416 person years). Risk of cardiovascular-disease mortality was higher among non-participants in associations/club meetings (22%) and outdoor activities (23%), respectively, as well as non-attendees of art exhibitions (28%). People who engaged in music, singing, and theatre had a 27% reduced risk of cancer-related mortality when compared to non-participants. Among women, participating in associations/club meetings reduced the risk of cardiovascular-disease mortality by 36%. Men who participated in music, singing, and theatre had a 33% reduced risk of cancer mortality. Overall, a reduced risk of cardiovascular-disease mortality was associated with engaging in creative activities on weekly basis to less than twice per week. For both genders, participating in creative activities less than once a week reduced cardiovascular-disease mortality risk by 40% and 33%, respectively. For the overall sample, participating > 2 times per week in combined receptive and creative activities reduced cancer-related mortality by 29%. Participating frequently in both receptive and creative activities cultural activities was associated with lower risks of CVD and cancer-related mortality. Our data suggest that, to counteract the public health burden of cardiovascular disease- and cancer mortality, policies and initiatives to increase citizens' participation in cultural activities should be considered.

Planetary Health Humanities-Responding to COVID Times

The coronavirus pandemic has shattered our world with increased morbidity, mortality, and personal/social sufferings. At the time of this writing, we are in a biomedical race for protective equipment, viral testing, and vaccine creation in an effort to respond to COVID threats. But what is the role of health humanities in these viral times? This article works though interdisciplinary connections between health humanities, the planetary health movement, and environmental humanities to conceptualize the emergence of "planetary health humanities." The goal of this affinity linkage is to re-story health humanities toward promotion of planetary health and community well-being. Wellbeing is critical because the main driver of environmental destruction and decreasing planetary health is coming from non-sustainable definitions of wellbeing. We need the arts and humanities to help reimagine the possibility of a sustainable community wellbeing. For health humanities, a basic role and narrative identity starts to emerge-we should become a planetary health (and well-being) humanities.

Artspace: Enabling young women's recovery through visual arts: A qualitative study

ISSUE ADDRESSED

This article reports the qualitative evaluation of "Artspace," an innovative clinical program combining creative arts with physical and mental health care for young women. The program, provided since 2004, comprises weekly visual arts sessions alongside a youth health clinic offering drop-in appointments with a nurse, GP and counsellor.

METHODS

A qualitative evaluation of Artspace was conducted between 2016 and 2017.

RESULTS

The evaluation showed that Artspace was particularly beneficial for those clients who had considerable exposure to social adversity and trauma, and were experiencing related serious health impacts. Artspace facilitated their recovery by enabling equitable access facilitation, social inclusion, creating a "holding" environment, and through the directly therapeutic benefits of artist-led arts processes.

CONCLUSIONS

Our study highlights the positive impact of artist-led programs such as Artspace. It also attests to the importance of long-term sustainability of services, to allow the time needed for young people to experience genuine and sustained recovery, and to reduce the otherwise likely disadvantages associated with mental and physical health problems, as they move into their adult lives. SO WHAT?: Youth health researchers have been recommending arts programs at health services as a means of engaging young people in health care for over 15 years, however, it remains an underutilised approach in primary care settings. Our evaluation affirms the effectiveness of art programs for this, and also demonstrates that art programs can be a key contributor to recovery from the serious health impacts of adversity and trauma.

Intergenerational understandings of personal, social and community assets for health

Connecting local citizens of different ages in productive social activity is considered a pathway towards greater health. This research explores how older adults and young people interpret and access assets from their geographical community in relation to their well-being and the extent to which a process of intergenerational bridging contributes to the creation of additional assets for health. Data is presented from a process of place-mapping, interviews, observations and arts-based approaches to: a) understand how personal, social and community assets supported perceived health and wellbeing for the young children and older adults who participated; and b) explore the impact of intergenerational connection on enhancing social capital. The research utilised bonding, bridging and linking forms of social capital, across several interactions amongst 41 individuals who reside in the same geographical community (Victoria, Australia). Assets for health, common across generations and located within the same geographical community were identified. Social connections were strengthened through conversations, reflections and an integration of ideas facilitated through an arts-based approach. Findings suggest that through intergenerational connection and sharing of resources to support health, including the sharing of community assets, progress can be made towards community strengthening with implications for health and wellbeing.

Nurse Perceptions of Artists as Collaborators in Interprofessional Care Teams

Increased attention is being given to interprofessional collaboration in healthcare, which has been shown to improve patient satisfaction, patient safety, healthcare processes, and health outcomes. As the arts and artists are being more widely incorporated into healthcare settings throughout the world, professional artists are contributing to interprofessional care teams. A secondary directed content analysis of interviews with 31 nurses on a medical-surgical care unit investigated the roles and impacts of professional artists on the interprofessional care team. The investigation utilized established domains of interprofessional care, including values and ethics, roles and responsibilities, interprofessional communication, and teams and teamwork, and created the domain of quality of care. Findings suggest that artists are valued by nurses as members of the interprofessional care team, that they enhance the provision of patient-centered care, and that they improve quality of care by providing holistic dimensions of caring, including cognitive and social engagement, and meaningful interaction. The presence of artists on interprofessional teams provides a cost-effective and welcome resource for clinical staff and builds a culture in which creativity and interdisciplinary collaboration are more highly valued and activated.

Provision of arts therapies for people with severe mental illness

PURPOSE OF REVIEW

Arts therapies are still inadequately regulated throughout the world despite a 100-year-long tradition, a vast number of academically trained therapists and importance in treating psychiatric patients. It is essential that more evidence-based studies are undertaken.

RECENT FINDINGS

Current international guidelines focus on the efficacy and effectiveness of arts therapies. New international evidence-based studies reporting clear-cut therapeutic effects of art therapy, music therapy and dance movement therapy are described here, with a focus on developments in Australia, Egypt and the United States.

SUMMARY

Further effort must be put into the development of evidence-based treatment programmes for all arts therapies, and effort needs to go into the establishment of arts therapists as a profession, with appropriate training standards.