Arts on Prescription: A review of practice in the UK

'Unmasking Pain' through creativity: A phenomenological study of person-centred pain exploration for people living with chronic pain

'Unmasking Pain' is an innovative artist-led project to explore creative approaches for telling stories of life with persistent pain. The purpose of this qualitative study was to explore and describe the lived experience of taking part in 'Unmasking Pain' from the perspectives of people living with pain (workshop attendees), artists (workshop facilitators) and pain rehabilitation specialists. Informed by descriptive phenomenology, data was collected via semi-structured interviews with three artists (workshop facilitators), five workshop attendees (all living with persistent pain) and one pain rehabilitation specialist. Data was analysed using thematic analysis for descriptive phenomenology. Three themes emerged from the analysis: Theme 1 Space to Breathe, reflects the context of 'Unmasking Pain' such as the conditions, environment and setting that people experienced; Theme 2 Flexibility to Participate, reflects the experience of the process of 'Unmasking Pain' such as the actions or internal workings/behaviours of the experience; and Theme 3 Possibility for Change, reflects the cognitive or emotional experience of 'Unmasking Pain'. There were nine sub-themes: 1(a) Dissolved hierarchy, 1(b) Human connection, and 1(c) Personally meaningful; 2(a) Go with the flow, 2(b) Enjoyable experience, and 2(c) Curiosity to step into the unknown; and 3(a) Reforming pain, 3(b) Liberating in the moment (now), and 3(c) Gives you a boost (future). In conclusion, the uniqueness of 'Unmasking Pain' was to creatively facilitate curiosity and exploration of pain in a non-clinical, sociocultural, humanised context, to enable the possibility of a different pain experience. The findings from this qualitative study exploring the lived experience of taking part in 'Unmasking Pain' demonstrates the power and opportunity of the Arts sector and artist-led activities to support people with chronic pain to have a better pain experience.

Unveiling the Transformative Potential of AI-Generated Imagery in Enriching Mental Health Research

Visual methods in mental health research have been extensively explored and utilized following the expanse of art-therapy. The existing literature shows visual arts as a valuable research method with multi-fold benefits for both researchers and research participants. However, the way contemporary art is understood, conceptualized, and experienced has been challenged by the current digital advancements in our society. Despite heated debates whether AI may diminish the value of human creativity, AI-generated art is a complex reality that started to influence the way visual research is conducted. Within this context, researchers employing visual methods need to develop a deeper understanding of this topic. For this purpose, this article explores the concept of AI-generated images with a focus on benefits and limitations when applied to mental health research and potentially other areas of health and social care. As this is an emerging topic, more research on the effectiveness and therapeutic value of AI-generated images is required beyond the current anecdotical evidence, from the perspective of the researchers and research participants.

Implementing Arts on Prescription at Home for People Living With Dementia: A Hybrid-Effectiveness Feasibility Study

Arts on prescription at home (AoP@Home) is a participatory art-based approach involving a professional artist engaging a person with dementia (and their family carer) in art-making in their own home. This study evaluated the implementation of AoP@Home within a real-world community aged care context. A hybrid effectiveness-implementation design was used to simultaneously test both the AoP@Home intervention and the implementation process. AoP@Home program outcomes included person with dementia and family carer (dyad) health and wellbeing, and personal goal attainment. Implementation outcomes were evaluated according to feasibility, fidelity, acceptability, uptake, and costs via routinely collected data, artist notes, and interviews with program managers, artists, and participant dyads. Four dyads completed an AoP@Home program during the study period. All participants with dementia reported improvements in their overall health and wellbeing, and wellbeing scores improved for all carers from baseline to post-program. Implementation was feasible using existing government funding mechanisms, and programs were acceptable to all stakeholders. It is possible to deliver participatory arts programs for community-dwelling people with dementia and their family, in their home, using sustainable and available funding models. Programs such as AoP@Home should be made more accessible alongside broader allied health and care services.

The impact of arts on prescription on individual health and wellbeing: a systematic review with meta-analysis

Introduction

The evidence-base for the impact of participating in the arts for different aspects of health and wellbeing is growing. Arts on Prescription has gained increasing recognition as a method for fostering connections among individuals and communities, however, to date no systematic review of the impact on individual health and wellbeing has been conducted. This review aims to provide an understanding of individual health and wellbeing outcomes from participation in Arts on Prescription programmes.

Methods

Major electronic databases were systematically searched, including Cochrane Library; Web of Science; ProQuest; CINAHL; Arts & Humanities; Ebsocohost; Pubmed; PsycINFO. Other databases were also used: Google Scholar and websites of specific organizations, e.g., NHS Evidence, Kings Fund, Health foundation, Nuffield Trust and NESTA and University of Florida Arts-in Medicine Repository. The review used PRISMA reporting structures. Critical Appraisal Skills Programme (CASP) templates were used for qualitative and quantitative studies, and the Mixed Methods Appraisal Tool (MMAT) for studies with a mixed methods protocol to assess quality and risk of bias. A narrative review of the qualitative data was conducted. For quantitative outcomes, a meta-analysis for studies that met inclusion criteria was conducted, and a narrative review made of secondary and heterogeneous outcomes and approaches.

Results

7,805 records were identified but only 25 records were included as studies with a focus on the impact on individual health and wellbeing. Studies were conducted in Australia, Denmark, Sweden, United Kingdom, and the United States. Programmes were held in community settings, arts venues, GP surgeries, primary healthcare settings, and one school. Most interventions varied from 8 to 10 weeks and included a wide range of different arts activities. Qualitative themes included social benefits, psychological benefits and progression opportunities. The meta-analysis showed a statistically significant improvement in wellbeing, and the narrative review identified promising outcomes that require further evidential support (e.g., reductions in anxiety and depression).

Discussion

Arts on Prescription programmes are an appropriate intervention for improving psychosocial wellbeing, providing both social and psychological benefits as well as progression opportunities. We discuss the various qualitative and quantitative outcomes, along with potential 'active ingredients' and barriers to participation (physical, psychological and social).

Systematic review registration

PROSPERO, identifier CRD42023408974, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023408974.

The experience of visual art for people living with mild-to-moderate vision loss

BACKGROUND

Visual art can enhance wellbeing and quality-of-life; however, the experience of visual art for people with mild-to-moderate vision loss has not been examined.

METHODS

Eight participants (6 females, 2 males; Mean age = 81 years, SD = 7.9, range 70-91 years; 4 with mild vision loss and 4 with moderate vision loss based on binocular visual acuity) completed a mixed-methods study comprising: a semi-structured interview on visual art experience; an eye examination; and questionnaires about visual functioning and quality-of-life.

RESULTS

Various themes were identified: visual perception of art (e.g. altered colours, visual distortions, etc.), viewing conditions, elements of art, personal preference, deriving meaning, appreciation of art, impact of impaired visual perception, and social aspects of art.

CONCLUSIONS

The overall experience of art is influenced by how an individual sees, perceives, and makes meaning from art. Even mild vision loss can impair this experience and impact emotional and social wellbeing.

"You're sort of building community in a bigger way": exploring the potential of creative, nature-based activities to facilitate community connections

BACKGROUND

This paper explores the opportunities that creative, nature-based activities offer for mobilising social connections via community-centred approaches to improve individual and collective wellbeing.

METHODS

The study involved ethnographic methods and data was gathered from a nature for wellbeing project implemented in a rural village in North East England.

RESULTS

The findings indicate creative, nature-based activities delivered within an environment marked by an ethic of care and kindness enabled the project to engage with participants at individual and collective levels simultaneously, which enhanced the project's ability to mobilise community skills and assets, and affect connectedness, equity and control within social groups facing significant disadvantages.

CONCLUSION

Creative, nature-based activities, delivered with an ethic of care, present an opportunity to recognise and engage complex and, at times, opposing undercurrents inherent in social connections between individuals and social groups.

Co-design of 'Ways of Being', a web-based experience to optimise online arts and culture for mental health in young people

AIMS AND METHOD

We aimed to co-design an intervention optimising the benefits of online arts and culture for mental health in young people for subsequent testing in a trial. Co-design followed the double diamond phases of design, discover, define, develop and deliver.

RESULTS

Navigating the views of all co-designers to produce a testable resource demanded in-depth understanding, and frequent iterations in multiple modalities of the theoretical basis of the intervention, amplification of youth voice and commitment to a common goal.

CLINICAL IMPLICATIONS

Co-design with a broad range of collaborators with a shared vision was valued by young co-designers and produced an effective intervention. Co-design allowed the theoretical basis to be followed and refined to create an engaging, practical and testable web experience, aiming to optimise the mental health benefits of online arts and culture for young people in a randomised controlled trial.

Practitioner Review: Effectiveness and mechanisms of change in participatory arts-based programmes for promoting youth mental health and well-being - a systematic review

BACKGROUND

Participatory arts-based (PAB) programmes refer to a diverse range of community programmes involving active engagement in the creation process that appear helpful to several aspects of children's and young people's (CYP) mental health and well-being. This mixed-methods systematic review synthesises evidence relating to the effectiveness and mechanisms of change in PAB programmes for youth.

METHOD

Studies were identified following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach. Eleven electronic databases were searched for studies of PAB programmes conducted with CYP (aged 4-25 years), which reported mental health and well-being effectiveness outcomes and/or mechanisms of change. A mixed-methods appraisal tool assessed study quality. A narrative synthesis was conducted of effectiveness and challenges in capturing this. Findings relating to reported mechanisms of change were integrated via a metasummary.

RESULTS

Twenty-two studies were included. Evidence of effectiveness from quantitative studies was limited by methodological issues. The metasummary identified mechanisms of change resonant with those proposed in talking therapies. Additionally, PAB programmes appear beneficial to CYP by fostering a therapeutic space characterised by subverting restrictive social rules, communitas that is not perceived as coercive, and inviting play and embodied understanding.

CONCLUSIONS

There is good evidence that there are therapeutic processes in PAB programmes. There is a need for more transdisciplinary work to increase understanding of context-mechanism-outcome pathways, including the role played by different art stimuli and practices. Going forward, transdisciplinary teams are needed to quantify short- and long-term mental health and well-being outcomes and to investigate optimal programme durations in relation to population and need. Such teams would also be best placed to work on resolving inter-disciplinary methodological tensions.

The impact of theatre on social competencies: a meta-analytic evaluation

BACKGROUND

There has been agrowing interest in using artistic interventions as a method of developing interpersonal competence. This paper presents a meta-analysis evaluating the impact of theatre interventions on social competencies.

METHODS

Twenty-one primary studies totaling 4064 participants were included, presenting evidence available since 1983. Included studies were assessed in terms of quality, heterogeneity, and publication bias.

RESULTS

Our findings indicated that active theatre participation significantly improved participants' empathic abilities, social communication, tolerance, and social interactions, with the largest pooled effect size for social communication (0.698) and the smallest for tolerance (0.156). Our findings did not corroborate the impact of theatre on self-concept.

CONCLUSIONS

This paper shows that theatre interventions have a positive impact on social competencies. The paper makes a methodological contribution by showing that randomized and non-randomized studies yielded comparably valid results.

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.

A co-produced online cultural experience compared to a typical museum website for mental health in people aged 16-24: A proof-of-principle randomised controlled trial

OBJECTIVE

We aimed to compare a co-produced online intervention encompassing the diverse human stories behind art and artefacts, named Ways of Being (WoB), with a typical museum website, the Ashmolean (Ash) on negative affect (NA), positive affect (PA) and psychological distress (K10).

METHODS

In this parallel group RCT, 463 YP aged 16-24 were randomly assigned, 231 to WoB and 232 to Ash.

RESULTS

Over the intervention phase (an aggregate score including all post-allocation timepoints to day-five) a group difference was apparent in favour of WoB for NA (WoB-Ash n=448, NA -0.158, p=0.010) but no differences were detected for PA or K10 and differences were not detected at week six. Group differences in NA in favour of WoB were detected in specific subgroups, e.g. ethnic minorities and males. Across participants (from both groups) mean K10 and NA improved between baseline and six weeks despite increased COVID-19 restrictions. Trial recruitment was rapid, retention high and feedback positive with broad geographical, occupational and ethnic diversity.

CONCLUSIONS

Online engagement with arts and culture has the potential to impact on mental health in a measurable way in YP with high unmet mental health needs.

Social prescribing for older people and the role of the cultural sector during the COVID-19 pandemic: What are link workers' views and experiences?

Older people's well-being can be bolstered by engaging with cultural activities and venues. They may be encouraged to try cultural offers by a link worker as part of social prescribing. However, the cultural sector, like all parts of life, was affected by the COVID-19 pandemic; this has had implications for cultural offers available to link workers. A study was conducted to explore the views and experiences of link workers in using the cultural sector within social prescribing, particularly for older people (aged 60+) during the pandemic. An online questionnaire was distributed to and completed by link workers in the UK. Data were analysed mainly using descriptive statistics. Open text responses were clustered into similar ideas to create key concepts. Useable responses were received from 148 link workers. They highlighted a general lack of interaction between link workers and the cultural sector about how the latter could support social prescribing. Results suggested that personal familiarity with cultural offers might prompt link workers to refer to them. Some respondents proposed that cultural offers were regarded as elitist, which deterred them from referring there. However, there was a general acknowledgement that the cultural sector could contribute to social prescribing. Link workers need to regard the cultural sector as accessible, appropriate, adequate, affordable and available before referring older people to cultural offers as part of social prescribing. Link workers may benefit from becoming more familiar with cultural sector staff and offers, including online resources, so they can then propose them to patients with confidence.

Use of online cultural content for mental health and well-being during COVID-19 restrictions: cross-sectional survey

AIMS AND METHOD

To gain a deeper understanding of the use of online culture and its potential benefits to mental health and well-being, sociodemographic characteristics and self-reported data on usage, perceived mental health benefits and health status were collected in an online cross-sectional survey during COVID-19 restrictions in the UK in June-July 2020.

RESULTS

In total, 1056 people completed the survey. A high proportion of participants reported finding online culture helpful for mental health; all but one of the benefits were associated with regular use and some with age. Reported benefits were wide-ranging and interconnected. Those aged under 25 years were less likely to be regular users of online culture or to have increased their use during lockdown.

CLINICAL IMPLICATIONS

There may be benefits in targeting cultural resources for mental health to vulnerable groups such as young adults.

Interventions for social and community participation for adults with intellectual disability, psychosocial disability or on the autism spectrum: An umbrella systematic review

Objective

This umbrella systematic review examined the effectiveness, facilitators, and barriers of interventions for social, community and civic participation for adults on the autism spectrum, or with intellectual or psychosocial disability.

Data Sources

Eight databases were searched to identify eligible reviews defined by the: Sample (≥50% adults on the autism spectrum or with intellectual or psychosocial disability), Phenomena of Interest (interventions in community settings that aimed to improve social, community or civic participation, or capacity to participate), Design (any), Evaluation (any method that evaluated impacts on participation or capacity to participate), and Research type (reviews as journal articles, dissertations or in grey literature, in English, published 2010-2020).

Review Methods

Rapid review methods were used. One researcher screened 27,890 records and 788 potentially eligible full texts. A second reviewer independently screened 20% of records, and ambiguous full text publications. Study quality was extracted, and review quality was assessed with the Assessing Methodological Quality of Systematic Reviews (AMSTAR) checklist. Data from 522 studies in 57 eligible systematic reviews were extracted for narrative synthesis. The Corrected Covered Area (CCA) was calculated to indicate overlap between reviews.

Results

There was a pooled sample of 28,154 study participants, predominantly from studies in North America, the UK and Europe. There was very low overlap between reviews (CCA = 0.3%). Reviews were predominantly low quality: 77.2% of reviews met <50% of AMSTAR criteria. Most studies were low (45.4%) or moderate (38.3%) quality. Three broad intervention categories improved participation, inclusion and belonging outcomes: (1) interventions to help people identify and connect with participation opportunities (e.g., person centred planning); (2) participation opportunities or activities (e.g., joining a community group, sports or outdoor activities, or arts-based activities); and (3) supports to build skills and capacity to participate socially and in the community.

Conclusions

The evidence highlighted that improved social and community participation requires purposeful strategies that identify meaningful participation preferences (e.g., where, when, how, and with whom) and provide support to build capacity or enable ongoing participation. Community capacity building, peer support and advocacy may also be needed to make the community more accessible, and to enable people to exercise genuine choice.

What does the literature mean by social prescribing? A critical review using discourse analysis

Social prescribing (SP) seeks to enhance the role of the voluntary and community sector in addressing patients' complex needs in primary care. Using discourse analysis, this review investigates how SP is framed in the scientific literature and explores its consequences for service delivery. Theory driven searches identified 89 academic articles and grey literature that included both qualitative and quantitative evidence. Across the literature three main discourses were identified. The first one emphasised increasing social inequalities behind escalating health problems and presented SP as a response to the social determinants of health. The second one problematised people's increasing use of health services and depicted SP as a means of enhancing self-care. The third one stressed the dearth of human and relational dimensions in general practice and claimed that SP could restore personalised care. Discourses circulated unevenly in the scientific literature, conditioned by a wider political rationality which emphasised individual responsibility and framed SP as 'solution' to complex and contentious problems. Critically, this contributed to an oversimplification of the realities of the problems being addressed and the delivery of SP. We propose an alternative 'care-based' framing of SP which prioritises (and evaluates) holistic, sustained and accessible practices within strengthened primary care systems.

Arts engagement facilitated by artists with individuals with life-limiting illness: A systematic integrative review of the literature

BACKGROUND

Living with life-limiting illness significantly impacts quality of life. A growing body of evidence suggests that arts engagement facilitated by artists promotes well-being. However, no synthesis of the literature exists to describe arts engagement delivered by artists with individuals receiving palliative care.

AIM

To systematically review and synthesize evidence to identify outcomes and key knowledge gaps to inform future research and practice.

DESIGN

A systematic integrative literature review was conducted using a pre-defined search strategy and reported using PRISMA guidelines. Analysis was conducted iteratively and synthesis achieved using constant comparison to generate themes.

DATA SOURCES

PubMed/MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Embase were searched for studies published between database inception and August 2020. Search terms included variations on arts/artists; patients/service users; and palliative or end-of-life care. Eligibility criteria was applied and study quality assessed.

RESULTS

Seven reviewed studies explored literary, performing, and visual arts engagement in hospitals, hospice and community settings in England, the United States, France, and Canada. Study designs, interventions and findings were discussed. Themes identified across studies associated arts engagement with (1) a sense of well-being, (2) a newly discovered, or re-framed, sense of self, (3) connection with others, and (4) challenges associated with practice.

CONCLUSION

Recommendations for future research were offered in order to maximize benefits, minimize risks and address complexity of artists' engagement in palliative care including: (1) consistency in methods and reporting; (2) inclusion of wider perspectives; and (3) key considerations for adapting the arts by health condition and art form.

Swedish primary healthcare practitioners' perspectives on the impact of arts on prescription for patients and the wider society: a qualitative interview study

Background

There is growing evidence that participating in arts activities are beneficial for mental health and wellbeing. Many patients attending primary care services have mental ill-health or social issues that healthcare practitioners currently do not have adequate ways of supporting. This study set out to explore the perspectives of primary healthcare practitioners on Arts on Prescription (AoP) as an additional referral pathway.

Methods

A qualitative exploratory descriptive approach within an interpretive framework using semi-structured interviews was used to explore healthcare practitioners’ perspectives and experiences of AoP programmes in Sweden. Ten interviews were conducted with healthcare practitioners in primary care. Data were analysed using an inductive thematic approach.

Results

The healthcare practitioners interviewed, recognised the need for more holistic approaches to care for those with mental health issues. They perceived that AoP is beneficial for patients in terms of motivation, creating routines, providing social interactions, and increasing self-esteem. In addition, AoP was felt to have the potential to impact upon current service provision and wider society. However, whilst the opportunity to refer patients to AoP in conjunction with conventional treatments was valued, participants reported that time pressures on practitioners and the continuing dominance of the medical model of care were barriers to wider acceptance amongst practitioners at the present time.

Conclusions

AoP enabled primary healthcare practitioners to offer an additional pathway for patients that is an adjunct to the traditional care pathway. However, the programmes tend to be project-based and often time limited. For programmes to be sustainable and be included as part of a wider range of interventions available to healthcare practitioners’ suitable levels of funding would be required.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07258-7.

Socio-economic inequalities in arts engagement and depression among older adults in the United Kingdom: evidence from the English Longitudinal Study of Ageing

OBJECTIVES

Arts engagement has been positively linked with mental health and well-being; however, socio-economic inequalities may be prevalent in access to and uptake of arts engagement reflecting on inequalities in mental health. This study estimated socio-economic inequality and horizontal inequity (unfair inequality) in arts engagement and depression symptoms of older adults in England. Trends in inequality and inequity were measured over a period of ten years.

STUDY DESIGN

This is a repeated cross-sectional study.

METHODS

In this analysis, we used data from six waves (waves 2 to 7) of the nationally representative English Longitudinal Study of Ageing. We estimated socio-economic inequality using concentration curves that plot the distribution of arts engagement and depression symptoms against the distribution of wealth. A concentration index was used to measure the magnitude of the inequality. Unfair inequality was then calculated for need-standardised arts engagement using a horizontal inequity index (HII).

RESULTS

The study sample included adults aged 50 years and older from waves 2 (2004/2005, n = 6620) to 7 (2014/2015, n = 3329). Engagement with cinema, galleries and theatre was pro-rich unequal, i.e. concentrated among the wealthier, but inequality in depression was pro-poor unequal, i.e. concentrated more among the less wealthy. While pro-rich inequality in arts engagement decreased from wave 2 (conc. index: 0·291, 95% confidence interval 0·27 to 0·31) to wave 7 (conc. index: 0·275, 95% confidence interval 0·24 to 0·30), pro-poor inequality in depression increased from wave 2 (conc. index: -0·164, 95% confidence interval -0·18 to -0·14) to wave 7 (conc. index: -0·189, 95% confidence interval -0·21 to -0·16). Depression-standardised arts engagement showed horizontal inequity that increased from wave 2 (HII: 0·455, 95% confidence interval 0·42 to 0·48) to wave 7 (HII: 0·464, 95% confidence interval 0·42 to 0·50).

CONCLUSIONS

Our findings suggest that while socio-economic inequality in arts engagement might appear to have reduced over time, once arts engagement is standardised for need, inequality has actually worsened over time and can be interpreted as inequitable (unfair). Relying on need-unstandardised estimates of inequality might thus provide a false sense of achievement to policy makers and lead to improper social prescribing interventions being emplaced.

Mental health and resilience: Arts on Prescription for children and young people in a school setting

OBJECTIVES

Arts on Prescription (AoP) programmes were among the first forms of social prescribing in the UK. Most of the studies of AoP programmes focus on adults and currently there is no published research on the impact of AoP on children and young people. This study investigates the impact of 10 weekly AoP workshops delivered in a school setting on the mental well-being and resilience of adolescents aged 13-16 years at risk of emotional or behavioural problems.

STUDY DESIGN

The study design used is a longitudinal cohort study of an AoP programme implemented in 10 schools in the East of England.

METHODS

Changes in mental well-being and resilience of school children were assessed using the Warwick-Edinburgh Mental Well-being Scale (WEMWBS), and the True Resilience Scale applied pre- and post-intervention, with follow-up at 3 months. In total, 91 young people participated in the programme and 65 completed pre- and post-intervention measures.

RESULTS

Data from the WEMWBS and True Resilience Scale indicated that the AoP Programme had a positive impact on both well-being and resilience of participants with a statistically significant increase recorded immediately post-intervention. However, these improvements were not sustained upon observation at 3-month follow-up.

CONCLUSION

This article presents the first indication of the effectiveness of a programme of AoP workshops on the mental well-being and resilience of children and young people. It suggests the potential of AoP as a means of support the mental health and well-being of secondary school aged children.

Associations between community cultural engagement and life satisfaction, mental distress and mental health functioning using data from the UK Household Longitudinal Study (UKHLS): are associations moderated by area deprivation?

OBJECTIVES

The association between community cultural engagement and mental health and well-being is well established. However, little is known about whether such associations are influenced by area characteristics. This study therefore examined whether the association between engagement in community cultural assets (attendance at cultural events, visiting museums and heritage sites) and subsequent well-being (life satisfaction, mental distress and mental health functioning) is moderated by neighbourhood deprivation.

DESIGN

Data were drawn from Understanding Society: The UK Household Longitudinal Study waves 2 and 5. Participating households' addresses were geocoded into statistical neighbourhood zones categorised according to their level of area deprivation.

SETTING

General population.

PARTICIPANTS

UK general adult population, with a total sample of 14 783.

MAIN OUTCOME MEASURES

Life satisfaction was measured with a seven-point scale (1: completely unsatisfied to 7: completely satisfied). Mental distress was measured using the General Health Questionnaire 12. Mental health functioning was measured using 12-item Short Form Health Survey (SF-12).

RESULTS

Using Ordinary Least Squares (OLS) regression, we found that engagement in cultural assets was consistently and positively associated with subsequent life satisfaction and mental health functioning and negatively associated with mental distress. Importantly, such associations were independent of individuals' demographic background, socioeconomic characteristics and regional location. The results also show that relationships between engagement in community cultural assets and well-being were stronger in more deprived areas.

CONCLUSIONS

This study shows that engagement in community cultural assets is associated with better well-being, with some evidence that individuals in areas of high deprivation potentially may benefit more from these engagements. Given that causal mechanisms were not tested, causal claims cannot be generated from the results. However, the results suggest that place-based funding schemes that involve investment in areas of higher deprivation to improve engagement rates should be explored further to see if they can help promote better well-being among residents.

The impact of the Arts and Dementia Program on short-term well-being in older persons with dementia from Singapore

OBJECTIVE

To investigate the impact of a locally developed Arts and Dementia Program on the short-term well-being of older persons with dementia in Singapore.

METHODS

Single-arm study with 21 persons with dementia. Behavioural tendencies and mood and engagement values were assessed using Dementia Care Mapping at baseline and during the program. The averaged mood and engagement value over the mapping period produced a well-/ill-being score for each person with dementia.

RESULTS

Well-/ill-being scores were significantly higher during the program compared to at baseline. The behavioural tendencies most frequently captured during the program were creative expression, reminiscence and leisure. In contrast, there were more eating or drinking behaviours during the baseline. Analyses revealed that the changes in occurrences of reminiscence, leisure, and eating or drinking behaviours across time were significant.

CONCLUSION

The present study suggests potential benefits of the Arts and Dementia Program in enhancing the well-being of persons with dementia.

Developing a framework for arts in health programs targeting individuals with chronic pain: a mixed-methods study of practitioners

OBJECTIVES

Chronic pain is a leading cause of morbidity and disability across the world. Cultural engagement may be a valuable tool in addressing the social disconnection that often accompanies chronic pain. This study sought to develop a framework for arts in health programs targeting individuals with chronic pain.

STUDY DESIGN

Sequential explanatory mixed-methods study.

METHODS

Web-based, cross-sectional survey sent to arts and cultural professionals to assess their experience with arts in health programming. Semi-structured interviews conducted with a sample of survey respondents to explore their perspectives on targeted arts in health programming for individuals with chronic pain.

RESULTS

Between October 2019 and January 2020, 208 surveys were completed by arts and cultural professionals. One hundred and twenty (58%) of the respondents indicated that they currently run an arts in health or museums in health program. Among these 120 respondents, 52 (43%) targeted older adults, 50 (42%) targeted individuals with mental health concerns, and 18 (15%) targeted individuals living with pain. Improving well-being (101 [84%]) and reducing social isolation (90 [75%]) were the most common intended program outcomes, while improving pain was the least common outcome (26 [22%]). Fifteen survey respondents were interviewed. Interviewees identified four interdependent themes regarding best practices for arts in health programs pertaining to (1) program content and structure, (2) program facilitation, (3) partnerships, and (4) programs for individuals with chronic pain.

CONCLUSIONS

The cultural sector can support chronic pain prevention and treatment efforts through the development of specialized programs. This study provides a framework for developing arts in health programs that support individuals living with chronic pain.

Tensions and opportunities in social prescribing. Developing a framework to facilitate its implementation and evaluation in primary care: a realist review

Background

Social prescribing (SP) involves linking patients in primary care with services provided by the voluntary and community sector (VCS). Despite growing interest within NHS primary care, it remains unclear how and under what circumstances SP might contribute to good practice.

Aim

To define ‘good’ practice in SP by identifying context-specific enablers and tensions. To contribute to the development of an evidence-based framework for theorising and evaluating SP within primary care.

Design & setting

Realist review of secondary data from primary care-based SP schemes.

Method

Academic articles and grey literature were searched for qualitative and quantitative evidence following the Realist And Meta-narrative Evidence Syntheses — Evolving Standards (RAMESES). Common SP practices were characterised in three settings (general practice, link workers, and community sector) using archetypes that ranged from best to worst practice.

Results

A total of 140 studies were included for analysis. Resources were identified influencing the type and potential impact of SP practices and four dimensions were outlined in which opportunities for good practice arise: 1) individual characteristics (stakeholder’s buy-in, vocation, and knowledge); 2) interpersonal relations (trustful, bidirectional, informed, supportive, and transparent and convenient interactions within and across sectors); 3) organisational contingencies (the availability of a predisposed practice culture, leadership, training opportunities, supervision, information governance, resource adequacy, accessibility, and continuity of care within organisations); and 4) policy structures (bottom-up and coherent policymaking, stable funding, and suitable monitoring strategies). Findings were synthesised in a multilevel, dynamic, and usable SP framework.

Conclusion

The realist review and resulting framework revealed that SP is not inherently advantageous. Specific individual, interpersonal, organisational, and policy resources are needed to ensure SP best practice in primary care.

Factors associated with attendance, engagement and wellbeing change in an arts on prescription intervention

BACKGROUND

Arts on prescription interventions have grown in number in recent years with a corresponding evidence base in support. Despite the growth and presence of these interventions, there have been no evaluations to date as to what factors predict patient success within these referral schemes.

METHODS

Using the largest cohort of patient data to date in the field (N = 1297), we set out to understand those factors that are associated with attendance, programme engagement and wellbeing change of patients. Factors associated with these outcomes were assessed using three binary logistic regression models.

RESULTS

Baseline wellbeing was associated with each outcome, with higher baseline wellbeing being associated with attendance and engagement, and lower baseline wellbeing associated with positive wellbeing change. Additionally, deprivation was associated with attendance, with those from the median deprivation quintile being more likely to attend.

CONCLUSIONS

The role of baseline wellbeing in each outcome of these analyses is the most critical associative factor. Whilst those that are lower in wellbeing have more to gain from these interventions, they are also less likely to attend or engage, meaning they may need additional support in commencing these types of social prescribing interventions.

Covid-19 and Mental Health: Could Visual Art Exposure Help?

A worldwidemental health crisis is expected, as millions worldwide fear death and disease while being forced into repeated isolation. Thus, there is a need for new proactive approaches to improve mental resilience and prevent mental health conditions. Since the 1990s, art has emerged as an alternative mental health therapy in the United States and Europe, becoming part of the social care agenda. This article focuses on how visual esthetic experiences can create similar patterns of neuronal activity as those observed when the reward system is activated. The activation of the reward structures could have a stress buffering effect, given the interdependence observed between the reward and stress systems. Therefore, could visual esthetic experiences stimulate mental resilience? And if this were the case, could art-based interventions be offered for mental health in the context of COVID-19 and beyond?

Validity of the Self-Expression and Emotion Regulation in Art Therapy Scale (SERATS)

Background

The Self-Expression Emotion Regulation in Art Therapy Scale (SERATS) was developed as art therapy lacked outcome measures that could be used to monitor the specific effects of art therapy. Although the SERATS showed good psychometric properties in earlier studies, it lacked convergent validity and thus construct validity.

Method

To test the convergent validity of the SERATS correlation was examined with the EES (Emotional Expressivity Scale), Emotion Regulation Strategies for Artistic Creative Activities Scale (ERS-ACA) and Healthy-Unhealthy Music Scale (HUMS). Patients diagnosed with a Personality Disorder, and thus having self-regulation and emotion regulation problems (n = 179) and a healthy student population (n = 53) completed the questionnaires (N = 232).

Results

The SERATS showed a high reliability and convergent validity in relation to the ERS-ACA approach strategies and self-development strategies in both patients and students and the HUMS healthy scale, in patients. Hence, what the SERATS measures is highly associated with emotion regulation strategies like acceptance, reappraisal, discharge and problem solving and with improving a sense of self including self-identity, increased self-esteem and improved agency as well as the healthy side of art making. Respondents rated the SERATS as relatively easy to complete compared to the other questionnaires.

Conclusion

The SERATS is a valid, useful and user-friendly tool for monitoring the effect of art therapy that is indicative of making art in a healthy way that serves positive emotion regulation and self-development.

Arts on prescription: observed changes in anxiety, depression, and well-being across referral cycles

OBJECTIVES

Arts on prescription (AoP) interventions are part of mainstream social prescribing provision in primary health care. Whilst the body of evidence for AoP interventions has been developing, this has primarily focused on well-being.

STUDY DESIGN

The present work is an observational longitudinal study on a community-based AoP social prescribing intervention in the South West UK.

METHOD

The present study assessed changes in anxiety, depression, and well-being in a cohort of patients participating in up to two eight-week cycles of AoP. The sample consisted of 245 individuals referred into the programme from 2017 to 2019, with a sub-sample of participants (N = 110) with identifiable multimorbidity. Outcomes were measured pre- and post-intervention at both initial and re-referral.

RESULTS

Anxiety, depression, and well-being were all significantly improved after initial referral, re-referral, and overall from initial to post re-referral for this intervention in the whole sample and multimorbid sub-sample. Multivariate analyses revealed that no participant variables appeared to account for the variance in outcome change scores.

CONCLUSION

The research provides further support for AoP interventions, finding associations with reduced anxiety and depression and increased well-being. Additionally, these outcomes are evidenced in those with multimorbidity, as well as across initial- and re-referral cycles.

'To more than I can be': A phenomenological meta-ethnography of singing groups for people with chronic obstructive pulmonary disease

Anecdotal experience and qualitative accounts suggest that singing groups, classes or choirs specifically for people with COPD (henceforth referred to as COPD-SGs) are effective in improving health. However, this is not reflected in the quantitative evidence. This meta-ethnography deployed phenomenological methods to explore this discrepancy. Analysis identified the phenomena of being together, being uplifted and being involved as central benefits of COPD-SGs. When viewed through the phenomenological lens of body-social as distinct from body-subject and body-object, findings demonstrated that the qualitative effectiveness of COPD-SGs is greatest on a collective basis. Qualitative research into the effectiveness of COPD-SGs offers more favourable results because phenomenological approaches can identify collective benefits that quantitative methods cannot. COPD-SGs should seek to maximise these collective benefits by rediscovering their cultural and artistic heritage within the national and global Arts in Health (AiH) movement, which has long emphasised the radical creative and healing power of group activity.

An Arts on Prescription Programme: Perspectives of the Cultural Institutions

Research on Arts on Prescription (AoP) programmes are on the increase and the participants' positive mental health outcomes are well-documented. However, there is insufficient research that considers the participating cultural institutions' perspectives. A qualitative focus group interview was conducted with the participating culture institutions in an AoP project in Denmark. Representatives from seven cultural institutions participated in the interview. The data was transcribed and analysed using Braun and Clark's (Qual Res Psychol 3(77):77-101. https://doi.org/10.1191/1478088706qp063oa , 2006) thematic approach. The cultural institutions were positive about the interdisciplinary collaboration with the Center for Mental Health and benefited from working with groups of people with mental health problems. They considered the collaboration to have encouraged skills development by working with groups that they did not regularly engaged with. If cultural institutions are to engage with the mental health wellbeing agenda then policy-driven initiatives can support collaborations that involve groups of people with mental health problems.

A Taxonomy of Arts Interventions for People With Dementia

BACKGROUND AND OBJECTIVES

The current evidence base for the arts and dementia has several limitations relating to the description, explanation, communication, and simplification of arts interventions. Research addressing these challenges must be multidisciplinary, taking account of humanities and science perspectives. Consequently, this research aimed to produce a taxonomy, or classification, of arts interventions for people with dementia as a contribution to this growing field.

RESEARCH DESIGN AND METHODS

This research was underpinned by taxonomy and realist methodology. Taxonomy, the science of classification, produces a common language to name, define, and describe the world around us. Realist theory explains how interventions "work" and produce their effects. The main findings in this paper were generated from a case study and a Delphi study.

RESULTS

An arts and dementia taxonomy of 12 dimensions was developed: Art Form, Artistic elements, Artistic focus, Artistic materials, Arts activity, Arts approaches, Arts facilitators, Arts location, Competencies, Complementary arts, Intervention context, Principles.

DISCUSSION AND IMPLICATIONS

Arts interventions can be classified according to their contexts, mechanisms, and outcomes. A range of stakeholders could benefit from the taxonomy, including people with dementia, artists, practitioners, carers, care staff, funders, commissioners, researchers, and academics. Language relating to the arts and dementia can be adapted depending on the audience. This is a foundational model requiring further development within the arts and dementia community.

Art, nature and mental health: assessing the biopsychosocial effects of a 'creative green prescription' museum programme involving horticulture, artmaking and collections

AIMS

To assess the biopsychosocial effects of participation in a unique, combined arts- and nature-based museum intervention, involving engagement with horticulture, artmaking and museum collections, on adult mental health service users.

METHODS

Adult mental health service users (total n = 46 across two phases) with an average age of 53 were referred through social prescribing by community partners (mental health nurse and via a day centre for disadvantaged and vulnerable adults) to a 10-week 'creative green prescription' programme held in Whitworth Park and the Whitworth Art Gallery. The study used an exploratory sequential mixed methods design comprising two phases - Phase 1 (September to December 2016): qualitative research investigating the views of participants (n = 26) through semi-structured interviews and diaries and Phase 2 (February to April 2018): quantitative research informed by Phase 1 analysing psychological wellbeing data from participants (n = 20) who completed the UCL Museum Wellbeing Measure pre-post programme.

RESULTS

Inductive thematic analysis of Phase 1 interview data revealed increased feelings of wellbeing brought about by improved self-esteem, decreased social isolation and the formation of communities of practice. Statistical analysis of pre-post quantitative measures in Phase 2 found a highly significant increase in psychological wellbeing.

CONCLUSION

Creative green prescription programmes, using a combination of arts- and nature-based activities, present distinct synergistic benefits that have the potential to make a significant impact on the psychosocial wellbeing of adult mental health service users. Museums with parks and gardens should consider integrating programmes of outdoor and indoor collections-inspired creative activities permitting combined engagement with nature, art and wellbeing.

Music on Prescription to Aid Sleep Quality: A Literature Review

Research on the efficacy of music for improving sleep quality has produced mixed results. We investigated whether the number of music dosages could be a reason for the lack of clarity. Six longitudinal music sleep studies using the Pittsburgh Sleep Quality Index (PSQI) over 3 weeks were identified. Music when compared to active (audiobooks or medication) or passive controls significantly improved (improvement is reflected by a lower score) PSQI within the first or second week of prescription. The improvement was an average mean difference of −1.15 (SD = 0.53) for each week. Music dosages continued to be associated with improved PSQI over a study that had a 3-month music intervention. One study with a low initial PSQI score resulted in poor sleepers (PSQI > 5) achieving healthy sleep (PSQI < 5) within 3 weeks of regular music intervention. For future studies, “prescribing” music beyond 3 weeks may lead to more instances of healthy sleep, particularly for those who have mild sleep problems. To explain the findings, we proposed that the relationship between weeks of music listening and improved PSQI are attributed to the truncation of poor bedtime habits linked to ruminative tendencies and consequent hyperarousal prior to the music intervention. Music listening at bedtime replaces those bad habits, we argue, by forming a new psychological link between bedtime and sleep through evaluative conditioning. The findings of the present study provide disarming evidence of the potential for prescription of music for treating mild sleep disorder.

'Creating health': evaluation of three arts for health training events for GP trainees

BACKGROUND

General practitioners (GPs) and other health professionals have a key role in signposting their patients to appropriate opportunities for engaging in arts and creative activities for the health and wellbeing benefits they may bring. Training is needed to ensure that GPs are aware of the evidence supporting the role of the arts, and the local availability of 'creative arts for health' activities for their patients.

AIM

This article describes the content and evaluation of three arts and health training events for trainee GPs conducted over the period 2016-2019. They took place in association with Guy's and St Thomas, Hillingdon and York and Scarborough General Practice Vocational Training Schemes (GPVTS).

METHODS

Evaluation was undertaken for the London events using a specially constructed questionnaire, with rating scales, completed before and after the training events. For the York event, a simple bespoke evaluation questionnaire was employed at the end of the training day. All participants gave consent for photography and filming during the events.

RESULTS

Feedback from GPs on the training events revealed increased awareness of the evidence for arts and health interventions, and more positive attitudes towards the role of creative arts in primary care in promoting the health and wellbeing of patients. An additional finding was a recognition by GP trainees that creative activities can enhance a holistic approach to patient care and play a positive part in supporting their own wellbeing.

CONCLUSION

Training events of the kind described, with opportunities for creative participation for GP trainees, can enhance awareness of the benefits of creative activity for patient health and wellbeing, and may motivate future GPs to signpost patients towards opportunities for engaging in creative activities. This training model is applicable for any health worker who can refer patients to arts for health activities and has potential to be scaled up nationally.

Tracking momentary experience in the evaluation of arts-on-prescription services: using mood changes during art workshops to predict global wellbeing change

Aims:

To measure the immediate impact of participating in arts-on-prescription workshops on multiple dimensions of mood and to evaluate whether improvement in mood is a mechanism for change, predicting improvements in global wellbeing before and after participation in arts-on-prescription programmes.

Methods:

The evaluation drew upon the experience sampling method, asking participants to complete a six-item mood questionnaire at the beginning and end of each workshop in a 12-week-long arts-on-prescription programme. Participants also completed a measure of global wellbeing at the beginning and end of the programme.

Results:

Multilevel modelling was used to test hypotheses since the data were hierarchical (with 1491 mood reports nested within 66 participants). There was a significant improvement in global wellbeing across participation in the arts-on-prescription programme. After each art workshop there was a significant increase on all dimensions of mood: hedonic tone (contentment); tense arousal (calmness); and energetic arousal (alertness). There was also a significant improvement in these dimensions of mood, over time, upon arrival at the art workshops each week. Furthermore, reduction in tense arousal after art workshops significantly predicted changes in global wellbeing.

Conclusion:

The findings suggest that a reduction in tense arousal (feeling less nervous, anxious and stressed) is a crucial component of arts-on-prescription services and make a direct link between experiences during art workshops and changes in global wellbeing for the first time. This strengthens the evidence base for arts-on-prescription and suggests that tracking experience across interventions is a useful evaluation tool, with much potential.

European Psychiatric Association (EPA) guidance on prevention of mental disorders

There is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence-based interventions. Since a large proportion of lifetime mental illness starts before adulthood, such interventions are particularly important during childhood and adolescence. Prevention is important for the sustainable reduction of the burden of mental disorder since once it has arisen, treatment can only reduce a relatively small proportion of such burden. The challenge for clinicians is to incorporate such interventions into non-clinical and clinical practice as well as engaging with a range of other service providers including public health. Similar strategies can be employed in both the European and global contexts. Promotion of mental well-being can prevent mental disorder but is also important in the recovery from mental disorder. This guidance should be read in conjunction with the EPA Guidance on Mental Health Promotion. This guidance draws on preparatory work for the development of England policy on prevention of mental disorder which used a wide range of sources.

What approaches to social prescribing work, for whom, and in what circumstances? A realist review

The use of non-medical referral, community referral or social prescribing interventions has been proposed as a cost-effective alternative to help those with long-term conditions manage their illness and improve health and well-being. However, the evidence base for social prescribing currently lags considerably behind practice. In this paper, we explore what is known about whether different methods of social prescribing referral and supported uptake do (or do not) work. Supported by an Expert Advisory Group, we conducted a realist review in two phases. The first identified evidence specifically relating to social prescribing in order to develop programme theories in the form of 'if-then' statements, articulating how social prescribing models are expected to work. In the second phase, we aimed to clarify these processes and include broader evidence to better explain the proposed mechanisms. The first phase resulted in 109 studies contributing to the synthesis, and the second phase 34. We generated 40 statements relating to organising principles of how the referral takes place (Enrolment), is accepted (Engagement), and completing an activity (Adherence). Six of these statements were prioritised using web-based nominal group technique by our Expert Group. Studies indicate that patients are more likely to enrol if they believe the social prescription will be of benefit, the referral is presented in an acceptable way that matches their needs and expectations, and concerns elicited and addressed appropriately by the referrer. Patients are more likely to engage if the activity is both accessible and transit to the first session supported. Adherence to activity programmes can be impacted through having an activity leader who is skilled and knowledgeable or through changes in the patient's conditions or symptoms. However, the evidence base is not sufficiently developed methodologically for us to make any general inferences about effectiveness of particular models or approaches.

Culture Vitamins - an Arts on Prescription project in Denmark

AIMS

Four Arts on Prescription (AoP) projects are piloting in Denmark between 2016 and 2019. One of the local authorities delivering the project is Aalborg. The AoP project 'Culture Vitamins' runs for 10 weeks and offers a variety of cultural activities averaging 2.5 workshops per week for participants with mild to moderate depression, stress or anxiety. The study aims to evaluate and explore the potential mental health wellbeing benefits for the participants.

METHOD

A qualitative approach with semi-structured interviews was used and included seven participants who were referred to the project by the local job centre. A thematic approach was applied to analyse the data and a theoretical lens of Salutogenesis was employed to explore the findings.

FINDINGS

The findings associated with mental health and the themes that emerged from the data described the participants' subjective experiences and were (1) positive changes, (2) overcoming challenges and being in the 'space' and (3) moving from self-critical to self-caring. The reported mental health benefits were increased energy level, increased self-esteem, more joy in life, less panic attacks, increased motivation, a better understanding of own needs, an increased level of self-care and, in addition, some of the participants said that they felt more aligned to the labour market.

CONCLUSIONS

The AoP project offered value and meaning for the participants and can be seen as a motivating tool that created access to new experiences and understandings by means of arts engagement. The 'Culture Vitamins' project can be regarded as a catalyst for connecting with inner resources and unlocking some of the barriers that mental ill health has created. The experience has shifted the participants' experience of themselves in the world and initiated their motivation for the future. The 'Culture Vitamins' project offered a positive contribution to public health challenges associated with stress, anxiety and depression of individuals.

'Artlift' arts-on-referral intervention in UK primary care: updated findings from an ongoing observational study

Background

Arts for health interventions are an accepted option for medical management of mental wellbeing in health care. Updated findings are presented from a prospective longitudinal follow-up (observational) design study of an arts on referral programme in UK general practice, over a 7-year period (2009-2016).

Methods

Primary care process and mental wellbeing outcomes were investigated, including progress through the intervention, changes in mental wellbeing, and factors associated with those outcomes. A total of n =1297 patients were referred to an eight or 10-week intervention over a period from 2009 to 2016. Patient sociodemographic information was recorded at baseline, and patient progress (e.g. attendance) assessed throughout the intervention.

Results

Of all referrals, 51.7% completed their course of prescribed art (the intervention). Of those that attended, 74.7% engaged with the intervention as rated by the artists leading the courses. A significant increase in wellbeing was observed from pre- to post-intervention (t = -19.29, df =523, P < 0.001, two-tailed) for those that completed and/or engaged. A sub sample (N =103) of these referrals self-reported multi-morbidities. These multiple health care service users were majority completers (79.6%), and were rated as having engaged (81.0%). This group also had a significant increase in well-being, although this was smaller than for the group as a whole (t = -7.38, df =68, P < 0.001).

Conclusion

Findings confirm that art interventions can be effective in the promotion of well-being for those that complete, including those referred with multi-morbidity, with significant changes in wellbeing evident across the intervention periods.

Arts on prescription for community-dwelling older people with a range of health and wellness needs

Published evidence for the role of participatory art in supporting health and well-being is growing. The Arts on Prescription model is one vehicle by which participatory art can be delivered. Much of the focus of Arts on Prescription has been on the provision of creative activities for people with mental health needs. This Arts on Prescription program, however, targeted community-dwelling older people with a wide range of health and wellness needs. Older people were referred to the program by their healthcare practitioner. Professional artists led courses in visual arts, photography, dance and movement, drama, singing, or music. Classes were held weekly for 8-10 weeks, with six to eight participants per class, and culminated with a showing of work or a performance. Program evaluation involved pre- and postcourse questionnaires, and focus groups and individual interviews. Evaluation data on 127 participants aged 65 years and older were available for analysis. We found that Arts on Prescription had a positive impact on participants. Quantitative findings revealed a statistically significant improvement in the Warwick-Edinburgh Mental Well-being Scale (WEMWBS) as well as a statistically significant increase in the level of self-reported creativity and frequency of creative activities. Qualitative findings indicated that the program provided challenging artistic activities which created a sense of purpose and direction, enabled personal growth and achievement, and empowered participants, in a setting which fostered the development of meaningful relationships with others. This evaluation adds to the evidence base in support of Arts on Prescription by expanding the application of the model to older people with a diverse range of health and wellness needs.

How do artistic creative activities regulate our emotions? Validation of the Emotion Regulation Strategies for Artistic Creative Activities Scale (ERS-ACA)

There is a rich literature exploring emotional responses to engaging in artistic creative activities such as making music, writing, dancing and crafts. However, it remains unclear how such activities affect our emotions; specifically which mental processes ('strategies') are used to regulate our emotional responses. This paper therefore describes the design and validation of a novel instrument measuring types of emotional regulation strategies (ERSs) used when engaging in artistic creative activities: the Emotion Regulation Strategies for Artistic Creative Activities Scale (ERS-ACA). Using data from an initial pilot study (n = 740 adults, 80.4% female, median age 25-34) and a follow-up large internet sample (n = 47,924, 56.7% female, average age 47.3 ± 14.6 years), we followed a theory-driven iterative factor analysis process. Our analyses converged on a final 18-item scale comprising an overall 'general' factor of ERSs alongside three subscales: a 7-item factor comprising 'avoidance strategies' (such as distraction, suppression and detachment), a 6-item factor comprising 'approach strategies' (such as acceptance, reappraisal and problem solving), and a 5-item factor comprising 'self-development strategies' (such as enhanced self-identify, improved self-esteem and increased agency). All factors showed strong internal reliability (Cronbach's alpha: General Factor = 0.93, Factor 1 = 0.9, Factor 2 = 0.88, Factor 3 = 0.88). We confirmed strong convergent and divergent validity, construct validity, consistency of internal reliability and test-retest reliability of the scale in a third study (n = 165, 82.2% female, average age 46.3 ± 12.2 years). In conclusion, artistic creative activities appear to affect our emotions via a number of ERSs that can be broadly classified into three categories: avoidance, approach and self-development. The ERS-ACA scale presented and validated here should support further research into the use of ERSs when engaging in artistic creative activities and enhance our understanding about how these activities affect mental health.

Factors affecting general practice collaboration with voluntary and community sector organisations

Collaborative working between general practice (GP) and voluntary and community sector (VCS) organisations is increasingly championed as a means of primary care doing more with less and of addressing patients' "wicked problems". This paper aims to add to the knowledge base around collaborative practice between GPs and VCS organisations by examining the factors that aid or inhibit such collaboration. A case study design was used to examine the lived-experience of GPs and VCS organisations working collaboratively. Four cases, each consisting of a GP and a VCS organisation with whom they work collaboratively, were identified. Interviews (n = 18) and a focus group (n = 1) were conducted with staff within each organisation. Transcribed data were analysed thematically. Whilet there are similarities across cases in their use of, for example, Health Trainers and social prescribing, the form and function of GP-VCS collaborations were unique to their local context. The identified factors affecting GP-VCS collaboration reflect those found in previous service evaluations and the broader literature on partnership working; shared understanding, time and resources, trust, strong leadership, operational systems and governance and the "negotiation" of professional boundaries. While the current political environment may represent an opportunity for collaborations to develop, there are issues yet to be resolved before collaboration-especially more holistic and integrated approaches-becomes systematically embedded into practice.

The use of arts interventions for mental health and wellbeing in health settings

Aims:

This literature review aims to illustrate the variety and multitude of studies showing that participation in arts activities and clinical arts interventions can be beneficial for citizens with mental and physical health problems. The article is focused on mental health benefits because this is an emerging field in the Nordic countries where evidence is demanded from national health agencies that face an increasing number of citizens with poor mental health and a need for non-medical interventions and programmes.

Methods:

A total of 20 articles of interest were drawn from a wider literature review. Studies were identified through the search engines: Cochrane Library, Primo, Ebscohost, ProQuest, Web of Science, CINAHL, PsycINFO, PubMed and Design and Applied Arts Index. Search words included the following: arts engagement + health/hospital/recovery, arts + hospital/evidence/wellbeing, evidence-based health practice, participatory arts for wellbeing, health + poetry/literature/dance/singing/music/community arts, arts health cost-effectiveness and creative art or creative activity + health/hospital/recovery/mental health. The inclusion criteria for studies were (1) peer review and (2) empirical data.

Results:

The studies document that participation in activities in a spectrum from clinical arts interventions to non-clinical participatory arts programmes is beneficial and an effective way of using engagement in the arts to promote holistic approaches with health benefits. Engagement in specially designed arts activities or arts therapies can reduce physical symptoms and improve mental health issues.

Conclusion:

Based on the growing evidence of the arts as a tool for enhancing mental health wellbeing, and in line with the global challenges in health, we suggest that participatory arts activities and clinical arts interventions are made more widely available in health and social settings. It is well-documented that such activities can be used as non-medical interventions to promote public health and wellbeing.

Art therapy as an adjuvant treatment for depression in elderly women: a randomized controlled trial

Objective:

There are few quantitative studies on art therapy for the treatment of depression. The objective of this study was to evaluate if art therapy is beneficial as an adjuvant treatment for depression in the elderly.

Methods:

A randomized, controlled, single-blind study was carried out in a sample of elderly women with major depressive disorder (MDD) stable on pharmacotherapy. The experimental group (EG) was assigned to 20 weekly art therapy sessions (90 min/session). The control group (CG) was not subjected to any adjuvant intervention. Patients were evaluated at baseline and after 20 weeks, using the Geriatric Depression Scale (GDS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and cognitive measures.

Results:

Logistic regression analysis adjusted for age revealed that women in EG (n=31) had significant improvement in GDS (p = 0.007), BDI (p = 0.025), and BAI (p = 0.032) scores as compared with controls (n=25). No difference was found in the cognitive measures.

Conclusion:

Art therapy as an adjunctive treatment for MDD in the elderly can improve depressive and anxiety symptoms.

Clinical trial registration:

RBR-2YXY7Z

Using the experience-sampling method to examine the psychological mechanisms by which participatory art improves wellbeing

AIMS

To measure the immediate impact of art-making in everyday life on diverse indices of wellbeing ('in the moment' and longer term) in order to improve understanding of the psychological mechanisms by which art may improve mental health.

METHODS

Using the experience-sampling method, 41 artists were prompted (with a 'beep' on a handheld computer) at random intervals (10 times a day, for one week) to answer a short questionnaire. The questionnaire tracked art-making and enquired about mood, cognition and state of consciousness. This resulted in 2,495 sampled experiences, with a high response rate in which 89% of questionnaires were completed.

RESULTS

Multi-level modelling was used to evaluate the impact of art-making on experience, with 2,495 'experiences' (experiential-level) nested within 41 participants (person-level). Recent art-making was significantly associated with experiential shifts: improvement in hedonic tone, vivid internal imagery and the flow state. Furthermore, the frequency of art-making across the week was associated with person-level measures of wellbeing: eudemonic happiness and self-regulation. Cross-level interactions, between experiential and person-level variables, suggested that hedonic tone improved more for those scoring low on eudemonic happiness, and further that, those high in eudemonic happiness were more likely to experience phenomenological features of the flow state and to experience inner dialogue while art-making.

CONCLUSION

Art-making has both immediate and long-term associations with wellbeing. At the experiential level, art-making affects multiple dimensions of conscious experience: affective, cognitive and state factors. This suggests that there are multiple routes to wellbeing (improving hedonic tone, making meaning through inner dialogue and experiencing the flow state). Recommendations are made to consider these factors when both developing and evaluating public health interventions that involve participatory art.

Global perspectives on dementia and art: An international discussion about changing public health policy

In an era of global environmental deterioration and income inequity, public health faces many challenges, including the growing number of individuals, especially older people, with chronic diseases. Dementia is increasingly being seen not just as a biomedical problem to solve but as a public and community challenge to address more broadly. Concepts like prevention, brain health, and quality of life/well-being are receiving more attention. The engagement of community in addressing these challenges is being seen as critical to successful social adaptation. Arts programs are reinvigorating cultural responses to the growing number of older people with cognitive challenges. The humanities offer ways of understanding the power of words and stories in public discourse and a critical lens though which to view political and economic influences. In this paper, we report on a panel held in London on the occasion of the conference at the Royal Society for Public Health in March, 2017, in which the authors presented. Key issues discussed included problem framing, the nature of evidence, the politics of power and influence, and the development of effective interventions. In this paper, we review the rejection of two policies, one on dementia and one on the arts and humanities in public health, by the American Public Health Association; the emergence of policies in the UK; and some of the state of the art practices, particularly in training, again focusing on the UK.