Reading Groups as a Health-Promoting Intervention in Upper Secondary Schools: A Qualitative Study

OBJECTIVES

To explore public health nurses' (PHN) perceptions and experiences of supporting siblings of children with complex care needs (CCNs) by using reading groups as a health promotion intervention in upper secondary schools.

DESIGN

An action research approach using a qualitative design.

SAMPLE

Interviews with 10 PHNs.

MEASUREMENTS

Thematic analysis.

RESULTS

The analysis resulted in the overarching theme "A much needed health promotion intervention in upper secondary schools," presented in terms of the following three themes: (1) supporting siblings is important, but resources and established procedures are lacking. (2) Reading groups using fiction have potential as a health-promoting intervention in upper secondary schools. (3) A realistic collaborative approach is necessary for reading groups to be implemented.

CONCLUSION

PHNs have no established procedures to support siblings of children with CCNs in upper secondary schools. Reading groups can enable PHNs to reach out and support these siblings. Providing the intervention can be a way of reaching all pupils and thus creating an understanding of the plight of siblings who have a brother or sister with CCNs.

Is it premature to formulate recommendations for policy and practice, based on culture and health research? A robust critique of the CultureForHealth (2022) report

Introduction

Arts and health practice and research has expanded rapidly since the turn of the millennium. A World Health Organization scoping review of a large body of evidence claims positive health benefits from arts participation and makes recommendations for policy and implementation of arts for health initiatives. A more recent scoping review (CultureForHealth) also claims that current evidence is sufficient to form recommendations for policy and practice. However, scoping reviews of arts and health research-without critical appraisal of included studies-do not provide a sound basis for recommendations on the wider implantation of healthcare interventions.

Methods

We performed a detailed assessment of 18 Randomised Controlled Trials (RCTs) on arts-based interventions included in Section 1 of the CultureForHealth report using the Joanna Briggs Institute Critical Appraisal Tool for RCTs (2023).

Results

The 18 RCTs included demonstrated considerable risks of bias regarding internal and statistical conclusion validity. Moreover, the trials are substantially heterogeneous with respect to settings, health-issues, interventions, and outcomes, which limits their external validity, reliability, and generalisability.

Conclusions

The absence of a critical appraisal of studies included in the CultureForHealth report leads to an overinterpretation and overstatement of the health outcomes of arts-based interventions. As such, the CultureForHealth review is not a suitable foundation for policy recommendations, nor for formulating guidance on implementation of arts-based interventions for health.

Music as a health resource in pregnancy: A cross-sectional survey study of women and partners in Ireland

BACKGROUND

Wellbeing in pregnancy can have long term effects for women, infants, and families. Research has shown that music can promote maternal health, infant development, and parent-infant bonding. This study aimed to explore women's and their partners' experiences of using music during pregnancy while also considering their perspectives on the potential role of music in maternity care.

METHODS

A cross-sectional online survey was conducted from June to October 2020 in Ireland. 265 respondents including 254 women and 11 partners who were pregnant or had given birth in the past 12 months participated. Descriptive statistics and content analysis were used to analyse the results.

RESULTS

Findings indicated that, during pregnancy, 75% of respondents sang to their unborn baby, 47% created playlists for childbirth, 46% intentionally used music to support their wellbeing, over one-third were not aware of supporting evidence on music for perinatal wellbeing, 88% thought there was not enough guidance, and 70% supported the idea of establishing music therapy in maternity care. Qualitative analysis revealed three themes: 'Positive impacts of music', 'Facilitators and barriers to the use of music during pregnancy', and 'Future visions on implementing music in maternity care'.

CONCLUSION

This study is the first to explore the experience and perspectives of women and partners in Ireland on using music during pregnancy. The findings highlight the need for more music-based resources and education on this topic and suggests an openness amongst women and partners towards the implementation of music therapy in maternity care to promote perinatal health and wellbeing.

Program development for leaders in the post-truth era: Arts-based creative leadership communication program

Developments in media and communication technologies welcomed a new era, defined as post-truth, implying a general distancing from truth, where fake or speculative messages can be instantly shared by a vast audience. In this era, we need leaders with strong emotional and social skills to create a positive and ethical impact in society. In this study, due to the requirements of the Post-Truth Era which necessitates a new approach to leadership development, an arts-based learning intervention entitled Arts-Based Creative Leadership Communication Program is designed for leaders with three main objectives to increase, firstly, their creative communication skills; secondly, healing effect of arts for their resilience; and, thirdly, their social sensitivity through arts. After the design and implementation of this program, its targeted effects on the participants were analyzed. Results indicated that all of the expected outcomes were achieved successfully. The highest development was seen in the healing effect, while change in social sensitivity appeared as the lowest. Emotional skills as non-verbal communication element was developed more than social skills. Meanwhile, the emergence of the pandemic with its digital transformation process increased the effects of the program. To sum up, the program was found successful for the leaders in the Post-Truth Era.

Music-based interventions in community settings: Navigating the tension between rigor and ecological validity

Empirical research of community-based music interventions has advanced to investigate the individual, social, and educational implications of arts-for-wellbeing practices. Here, we present the motivations, aims, hypotheses, and implications of this complex field of inquiry. We describe examples of recent large-scale investigations to reflect on the major methodological challenges. Community-based music interventions strike a balance between the empirical rigor of clinical trials and the demands of ecological validity. We argue that this balance should be viewed as an asset rather than a mere pragmatic compromise. We also offer some perspectives on best-practice models for effectively engaging in this type of work.

Creating an empirically-based model of social arts as a public health resource: Training, typology, and impact

Introduction

Mounting empirical evidence underscores the health benefits of the arts, as recently reported in a scoping review by the World Health Organization. The creative arts in particular are acknowledged to be a public health resource that can be beneficial for well-being and health. Within this broad context, and as a subfield of participatory arts, the term social arts (SA) specifically refers to an art made by socially engaged professionals (e.g., artists, creative arts therapists, social workers, etc.) with non-professionals who determine together the content and the final art product (in theater, visual arts, music, literature, etc.) with the aim to produce meaningful social changes. SA can enhance individual, community, and public health in times of sociopolitical instability and is an active field in Israel. However, SA is still an under-investigated field of study worldwide that is hard to characterize, typify, or evaluate. This paper presents a research protocol designed to examine a tripartite empirically-based model of SA that will cover a wide range of SA training programs, implementations, and impacts. The findings will help refine the definition of SA and inform practitioners, trainers, and researchers, as well as funding bodies and policymakers, on the content and impact of SA projects in Israel and beyond.

Methods and analysis

This 3-stage mixed methods study will be based on the collection of primary qualitative and arts-based data and secondary, complementary, quantitative data. Triangulation and member checking procedures will be conducted to strengthen the trustworthiness of the findings obtained from different stakeholders.

Discussion

Growing interest in the contribution of arts to individual and public health underscores the importance of creating an empirically grounded model for SA. The study was approved by the university ethics committee and is supported by the Israel Science Foundation. All participants will sign an informed consent form and will be guaranteed confidentiality and anonymity. Data collection will be conducted in the next 2 years (2022 to 2024). After data analysis, the findings will be disseminated via publications and conferences.

Systematic review of group-based creative arts interventions in support of informal care-givers of adults: a narrative synthesis

Informal care-givers play an important role, with health-care systems relying on the billions of hours of care they provide. Care-givers experience high levels of psychological distress and isolation; however, the efficacy of what support is the best for care-givers is unclear. The primary aim of this systematic review is to determine the effect of group creative arts interventions on informal care-givers of adults. The secondary aim is to understand the impact of group type, the primary outcomes and how they are measured. Given the heterogeneous nature of the included studies, a narrative synthesis approach was taken. Database searches identified 2,587 studies, 25 of which met the full inclusion criteria. Studies included group creative arts interventions for either care-givers only (N = 8) or for care-giver/cared-for dyads (N = 17). The majority of the participants in the studies were older Caucasian females. Group creative arts interventions are beneficial for care-givers and for the person being cared for; however, benefits differ depending on whether the group is for care-givers only or for care-giver/cared-for dyads. Future research will benefit from care-givers being involved in the design of the creative arts intervention to provide input regarding group type and relevant outcome measures. Future research should consider targeting their intervention to care-givers with a low baseline score to increase the ability of the study to demonstrate a significant difference.

Generating youth dialogue through the literary arts: A citywide youth health collaboration in the U.S

A process and outcomes evaluation was conducted of a citywide literary-arts initiative designed to reduce stigma, amplify underrepresented narratives, and generate dialogue about violence. Over 4 months, students in 85 middle schools read a novel addressing mental health and violence-related themes. As a collaboration between a public school district and public library system, the program's classroom activities emphasized dialogue, while coordinated library events supported community engagement. Students completed pre/postsurveys (total n = 1487); school program leaders (n = 39) and public librarians (n = 14) completed postsurveys. Half of student respondents reported personal encounters with violence. Most said the novel influenced their thinking; students with personal experiences of violence reported greater influence than those without. Highest rates of dialogue were seen among students who read the novel in full, and over half of postsurvey respondents wanted more dialogue opportunities. Leaders and librarians indicated that the program was smoothly integrated with existing curricula, but also offered recommendations for improved processes. Findings suggest that this intervention was effective at stimulating dialogue while providing assets-based opportunities for youth to share experiences and concerns. Current program processes indicate promise for further engagement and impact, with some modifications. To this end, authors draw upon evaluation findings and youth development literature to offer recommendations for program development and replication in other regions.

Examining the Range and Scope of Artists' Professional Practices With Individuals With Palliative Care Needs: An International, Cross-Sectional Online Survey

Background: Internationally, it is recognized that artists facilitate arts engagement with individuals with palliative care needs. There is a gap in the literature describing the range and scope of artists' professional practices in palliative care. The aim of this study was to examine an international range of professional practices among artists who work in palliative care including key professionals' perceptions of these practices. Methods: An international, cross-sectional, online survey was conducted with health professionals, artists, and program coordinators with experience with artists working in palliative care. This survey was part of a larger mixed methods study. An instrument was systematically developed to examine artists' professional practices. Descriptive statistics were reported for the total sample including frequencies, means and standard deviations and open-ended items were analyzed thematically. Results: 101 valid surveys were analyzed. Findings outlined: (1) who delivers the arts; (2) where and with whom; (3) practice descriptors; and (4) perceptions of practice. Themes identified from open-ended items on benefits and risks of practice revealed impacts on patients and artists alike, including: (1) enhanced well-being; (2) vulnerabilities; and (3) facilitators and barriers. Conclusion: Findings demonstrated a wide range of artists' practices in palliative and end-of-life care, featuring notable consistencies in international practice worth further exploration. Ongoing and international efforts examining artists' practices in palliative care contribute to the development of future research, policy and practice.

Active and receptive arts participation and their association with mortality among adults in the United States: a longitudinal cohort study

OBJECTIVES

The aim of the study was to explore associations between active and receptive arts participation and all-cause mortality among adults in the United States population.

STUDY DESIGN

This was a prospective cohort study.

METHODS

Data were derived from the Health and Retirement Study. Separate Cox proportional hazards models were constructed for two cohorts (2012 and 2014) to examine associations between arts participation and mortality.

RESULTS

Independent of sociodemographic and health factors, participants aged ≥65 years had a higher mortality risk if they did not engage in music listening, hazard ratio (HR) 1.39 (95% confidence interval [CI]: 1.12-1.71); singing/playing an instrument, HR 1.49 (95% CI: 1.07-2.0); or doing arts and crafts, HR 1.39 (95% CI: 1.00-1.92). For participants aged <65 years, there was a higher mortality risk if they did not listen to music, HR 1.79 (95% CI: 1.07-3.01). Older participants from the 2014 cohort had a higher mortality risk if they did not engage in active arts, HR 1.73 (95% CI: 1.08-2.77).

CONCLUSIONS

Engagement in the arts was associated with lower risk of mortality even after risk adjustment, especially for adults aged ≥65 years. Greater access and integration of arts in everyday life is recommended.

Performing arts as a health resource? An umbrella review of the health impacts of music and dance participation

An increasing body of evidence notes the health benefits of arts engagement and participation. However, specific health effects and optimal modes and 'doses' of arts participation remain unclear, limiting evidence-based recommendations and prescriptions. The performing arts are the most popular form of arts participation, presenting substantial scope for established interest to be leveraged into positive health outcomes. Results of a three-component umbrella review (PROSPERO ID #: CRD42020191991) of relevant systematic reviews (33), epidemiologic studies (9) and descriptive studies (87) demonstrate that performing arts participation is broadly health promoting activity. Beneficial effects of performing arts participation were reported in healthy (non-clinical) children, adolescents, adults, and older adults across 17 health domains (9 supported by moderate-high quality evidence (GRADE criteria)). Positive health effects were associated with as little as 30 (acute effects) to 60 minutes (sustained weekly participation) of performing arts participation, with drumming and both expressive (ballroom, social) and exercise-based (aerobic dance, Zumba) modes of dance linked to the broadest health benefits. Links between specific health effects and performing arts modes/doses remain unclear and specific conclusions are limited by a still young and disparate evidence base. Further research is necessary, with this umbrella review providing a critical knowledge foundation.

An exploration of engagement in community based creative activities as an occupation for older adults

Purpose

The purpose of this study was to explore the experiences of older adults (aged 60 and over) participating in community-based creative arts. With an ever increasing ageing population, understanding the benefits of leisure occupations such as community creative arts will be vital for Occupational Therapists in facilitating participation and active engagement.

Design/methodology/approach

An empirical qualitative research design with an interpretive phenomenological approach was undertaken. A purposive sampling method enlisted four older adult volunteers whose experiences of creative arts were explored through semi-structured interviews. Interview data were analysed thematically.

Findings

Participants identified many benefits of engaging in community creative arts. Four main themes were identified, namely, “personal benefits”, “choice” in their occupation, “encouragement” to and from others, with the environment facilitating “socialising”. These resulted in improved occupational performance and positive well-being outcomes.

Originality/value

The study complements national policy and extends evidence-based practice on the potential well-being benefits on older adults. In support of the preventative agenda, occupational therapists may apply these findings to increase social prescribing within practice.

Dementia knowledge, art, research and education - Teaching primary school children about dementia

ISSUE ADDRESSED

To develop, implement and evaluate the impact of a short education intervention on the understanding of dementia through visual art by primary school-aged children.

METHODS

A series of three lessons were developed in consultation with a local schoolteacher and community artists and taught in a local primary school. Stage 2 students (8-10 years old) created an artwork about memory, learned about dementia and adapted their artworks to represent their developing understanding of dementia. Empirical data were collected through pre and postinterventions surveys and content analysis of the artworks.

RESULTS

Matched pre and postintervention survey data were obtained for 74 students and showed a significant improvement in seven domains. This indicated that the students had an increased understanding of dementia and its impact on the individual following the intervention. Matched artwork was analysed from lessons 1 and 3 for 109 students using a coding schema developed specifically for this project. The students developed their artwork to show memories fading or being lost altogether. They also used abstract shapes to create a sense of disorder and chaos.

CONCLUSION

Participation in the intervention was shown to increase students' understanding and knowledge of dementia using both qualitative and quantitative measures. SO WHAT?: It is likely that by educating children about dementia, we have the potential to reduce the stigma faced by people living with dementia and their carers. This is important, as the ageing population means that more people within the community, including children, will know someone living with dementia. Further, this represents the cornerstone in creating dementia-friendly communities.

Effects of "Thursdays at the Museum" at the Montreal Museum of Fine Arts on the mental and physical health of older community dwellers: the art-health randomized clinical trial protocol

Background

Recently, we demonstrated that the Montreal Museum of Fine Arts’ (MMFA) participatory art-based activity, known as “Thursdays at the Museum,” improved the well-being, quality of life, and physical health (i.e., frailty) of older community dwellers by using a pre-post intervention, single arm, prospective and longitudinal experimental design. The present randomized clinical trial (RCT), known as the Art-Health RCT (A-Health RCT), aims to compare changes in well-being, quality of life, frailty, and physiological measures in older community dwellers who participate in “Thursdays at the Museum” (intervention group) and in their counterparts who do not participate in this art-based activity (control group).

Methods/design

The current unicenter, randomized, clinical, controlled, comparative trial recruits 150 older community dwellers to two parallel arms (75 participants in the intervention group and 75 participants in the control group). The intervention is a 3-month cycle of weekly “Thursdays at the Museum,” which are structured 2-h-long art-based workshops performed in a group setting at the MMFA. The control group is composed of participants who do not take part in art-based activities, receive their usual health and/or social services, and commit to report any other activity practiced during the same time. Assessments of the primary outcome (well-being) and the secondary outcomes (quality of life, frailty, and physiological measures including heart rate, daily step count, sleep duration, and its phases) are performed on six occasions: at baseline, at the beginning of the second and third months, at the end of the third month, as well as 6 and 12 months after the last workshop. Statistical analyses are performed with the intention to treat and per protocol. Comparisons of changes in outcome measures between intervention and control groups use repeated measures tests.

Discussion

Art-based activities carried out at museums have been receiving increased interest from researchers and policy-makers because of their benefits to mental and physical health. There are few robust studies, such as RCTs, that focus on older community dwellers or assess the efficacy of these participatory museum activities. The A-Health RCT study provides an opportunity to confirm the benefits of a participatory art-based museum activity on the elderly population and to show the key role played by museums in public health promotion.

Trial registration

NCT03679715; Title: A-Health RCT: Effects of Participatory Art-Based Activity on Health of Older Community Dwellers; First posted date: September 20, 2018; prospectively registered.

Plant Fetish: A Creative Challenge to Mental Health Stigma

People of BAMME (Black, Asian, Minority, and Migrant ethnic) heritage in the UK experience various anomalies when engaging with mental health services. Typically concentrated at secondary and secure levels of care, these discrepant experiences interact with a reticence to uptake mental health support at the primary care level. Official, national anti-stigma campaigns often reproduce messages that do not connect with BAMME communities, raising questions about how best to challenge stigma in this context. This research paper describes a case study of an alternative means to address stigma, drawing from a dramatic comedy performance, Plant Fetish, written and performed by an artist who carries a diagnosis of complex post-traumatic stress disorder (Complex PTSD). The study comprised of an individual interview with the artist, audience feedback, and a group discussion conducted after the show. Data were subject to interpretative phenomenological analysis. Findings are discussed in relation to the importance of using creativity to increase public awareness of mental health and inform efforts to reduce stigma. We conclude that such approaches show promise and merit further exploration in a context of growing discursive interest in mental health amidst acknowledged deficiencies of contemporary anti-stigma efforts, especially as they apply to BAMME people, their families, and their communities.

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.

Cultural activity at work: reciprocal associations with depressive symptoms in employees

PURPOSE

Several studies have shown that cultural activities may promote health. There are also prospective population studies which show that regular participation in cultural activities could reduce morbidity and mortality. To what extent such associations could be applied to the work arena is not so well known, although findings in a few studies support the assumption that cultural activities organized from the work site might improve employee health. An important question discussed in the literature is the extent to which associations between cultural activity at work and employee mental health could be reversed, for instance, with depressive mood resulting in withdrawal from cultural activity at work (backwords) rather than the opposite (forwards). The present study addresses this question.

METHODS

Using a biennial national job survey with seven waves (SLOSH), we examined 2-year follow-up periods in 7193 men and 9313 women in the years 2006-2018. The question regarding cultural activity at work was examined prospectively (using multilevel structural equation modelling) both forwards and backwards in relation to a standardized score for depressive mood (SCL-CD6) in participants working at least 30% both at start and end of the 2-year period.

RESULTS

The analyses were made separately for men and women and with age and education level as confounders. The findings show that there are highly significant prospective relationships for both men and women in both directions concomitantly.

CONCLUSIONS

Participation in cultural activity at work may protect employees from worsening depressive feelings, but depressive feelings may also inhibit participation in such activities.

'Dance to Health': an evaluation of health, social and dance interest outcomes of a dance programme for the prevention of falls

Background: Falls and related injuries in the older population are major public health issues requiring more innovative and effective solutions. This paper reports an evaluation of the Dance to Health (DtH) programme which integrates evidence-based physiotherapy falls-prevention exercises into creative dance.Methods: Sixty-seven participants took part in a mixed-methods study that combined focus group discussions and six pre/post-test questionnaires with a focus on dance interest and ability, group identity, loneliness and isolation, general health and mental health.Results: The findings show that the DtH programme can support and enhance physical, mental and social health and levels of interest in dance. The mixed data yielded evidence of positive change, with statistical significance in findings relating to group bonding and improved physical control and coordination.Conclusions: The findings support the case for recommending the Dance to Health programme in falls-prevention services in relation to its ability to promote a wide range of health and wellbeing benefits.

Arts for the Blues - a new creative psychological therapy for depression: a pilot workshop report

INTRODUCTION

Research over the last decade has identified both strengths and limitations in the use of routinely prescribed psychological therapies for depression. More recently, a focus on how creative art therapies and 'arts on prescription' are developing a growing recognition of their potential additional therapeutic mechanisms for depression.

AIM

In an attempt to develop a new therapeutic intervention for depression, this research aligned both the evidence base surrounding the arts on prescription movement, collating these with client-reported helpful factors and preferences for therapeutic interventions.

METHODS

We developed a framework for a new pluralistic 'meta-approach' of therapy for depression, based on; an interdisciplinary thematic synthesis of active ingredients, considered specific features implemented in therapy, and client-reported helpful factors considered to be the broad features or experiences in therapy from both talking therapies and creative approaches. This framework contributed to the development of a pilot workshop entitled Arts for the Blues - A New Creative Psychological Therapy for Depression. An outline of, and evaluation from this workshop is presented in this article. Workshop participants were recruited via a voluntary workshop taking place at a North West Higher Education Institution Arts and Health conference ( N = 15).

RESULTS

The workshop was evaluated using quantitative measures, with results indicating around a 70% overall satisfaction, followed up with qualitative commentary around areas of good practice and areas for development. These included the positive reflection on the application of creative arts and the multimodal nature of the approach, while others reflected on the potential overwhelming nature of utilising multimodal methods for individuals with depression.

CONCLUSION

Overall feedback from the pilot workshop is discussed in relation to prior research, giving credence to the potential for incorporating arts into therapy.

A Multisensory Multilevel Health Education Model for Diverse Communities

Owing to their enormous capacity to improve health and save lives, effective health promotion frameworks have been at the forefront of public health research and practice. A multilevel focus, as exemplified by the Socio-Ecological Model (SEM), is one common denominator among these frameworks. The SEM highlights important social and ecological influences on health behavior by delineating the different levels of influence. These include public policy, organizational, community, interpersonal, and intrapersonal levels, which, when considered during the development of health promotion campaigns, especially those that focus on health education, strengthen the potential influence of that campaign on targeted behaviors. However, the SEM lacks a complimenting framework for understanding the role of conventional and unconventional approaches to health education; that is, how to design a health education intervention that considers both the context, such as the social and ecological levels of influence, and the best approaches for developing and delivering the health education in a manner that optimizes their effectiveness in today's modern and increasingly diverse world. Addressing this gap, the current article presents an integrative Multisensory Multilevel Health Education Model (MMHEM), which incorporates three key domains-(1) Art (innovativeness/creativity), (2) Culture (cultural tailoring), and (3) Science (evidence-based), while promoting the importance of considering the socio-ecological levels of influence on targeted behaviors. Using a successful health education intervention, called the Hip Hop Stroke, we deconstruct the Multisensory Multilevel Health Education Model and discuss its potential role as a guide for developing public health education interventions.

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.

Facilitating creativity in dementia care: the co-construction of arts-based engagement

This paper seeks to understand the engagement of people with dementia in creative and arts-based activities by applying a relational model of citizenship and incorporating concepts of contextual and embodied learning from adult learning theory. A theoretically driven secondary analysis of observational and interview data focuses on the engagement of staff, volunteers and people with dementia during an arts-based intervention in a day centre and care home. The processes through which learning is co-constructed between the person with dementia, staff/volunteer facilitators and peers in the group to co-produce a creative engaged experience involves: increasing confidence for learning, facilitating social and physical connections, and affirming creative self-expression. The role of facilitator is central to the process of creative engagement to reinforce a sense of agency amongst participants and recognise people's prior experiences of learning and engagement in creative activities. People with dementia continue to learn and grow through engagement in creative activities to produce positive outcomes for the individual participants and for the care staff who observe and participate in this creativity. Facilitating creativity requires attention to lifelong experiences of learning in addition to the immediate interactional context to integrate arts-based interventions in dementia care successfully.

Psychobiological Effects of Choral Singing on Affective State, Social Connectedness, and Stress: Influences of Singing Activity and Time Course

Previous studies have suggested that there are complex psychobiological effects of amateur choral singing on well-being. Here, we investigate the influences of singing vs. non-singing on psychological and biological measurements, reflecting current positive and negative affect, perceived social connectedness, and physiological stress. We hypothesized that active singing leads to significant increases in these measurements compared to participating without singing. Amateur choristers (Exp. 1: N = 54, age range 18–85 years and Exp. 2: N = 49, age range 18–85 years) were tested in two experiments in which approximately half of the group was asked not to sing over periods of 30 (Exp. 1) and 60 min (Exp. 2), while the other half of the group sang. Dependent measures included scales for positive and negative affect and perceived social connectedness. In addition, saliva samples were collected to assess cortisol and alpha-amylase. The results revealed that singing activity had positive influences on affect measurements. However, significant increases in perceived social connectedness for singing were found only in Exp. 2. Biomarker changes were not significant across the experiments. Together, our findings suggest that both singing activity and duration of singing modulate psychological effects, with perceived social connectedness evolving over larger time spans than 30 min. Findings support the notion of beneficial psychological effects also for individuals, who report lower levels of general social support. The unexpected absence of biological effects warrants further investigation.

[Batas Nómadas in Madrid Salud: art and artists in professional community health teams]

OBJETIVE

This article describes the strategy of incorporating artists into the teams of community health in the city of Madrid, specifically in the Madrid Salud Centers.

METHOD

The artistic colletive, Batas Nómadas, formed by three artists expertized in visual arts, has developed performances and participatory aproach to explain the incorporation of art and artists in these teams of professionals of Madrid Salud.

RESULTS

Batas Nómadas has carried out sessions in 14 work teams of the Madrid Salud Centers and has collected data in a creative way from the 179 professionals that have participated in these sessions.

CONCLUSIONS

These actions have shown some needs in community health, and have noticed a meaningful reflection on the usefulness of the art to develop participative strategies into the Madrid Salud teams.

The creative turn in evidence for public health: community and arts-based methodologies

Background

We propose that arts based methodologies can be of value in the production and exchange of evidence in supporting public health related policy. This article reports on a collaborative piece of work resulting from two projects which took place in a former coal mining town in South Wales.

Methods

We used a participatory framework whereby researchers, community members and artists co-produced 'evidence' through the creative arts to inform public policy. We collected a range of data using a number of different techniques, including interviews, focus groups and observation, but also included an extensive range of creative activities.

Results

The data provided a diverse range of perspectives on how people of different ages live their lives. The People's Platform was a performance-based debate which was the culmination of the collaboration. The show involved a series of short performances with time for facilitated discussion in-between. It was felt that the show facilitated knowledge exchange on health and wellbeing issues that are usually difficult to express and understand through traditional forms of evidence.

Conclusion

Whilst arts-based approaches are not free from risk, they offer an alternative form of knowledge as a necessary complement to the range of data available to policy makers.

Introduction: Art and the brain: From pleasure to well-being

Empirical aesthetics in general, and neuroaesthetics in particular, have been very much influenced by Berlyne's psychobiological program. For him, aesthetic appreciation involved the brain's reward and aversion systems. From this point of view, art constitutes a set of potentially rewarding stimuli. Research has certainly made great advances in understanding how the process of artistic valuation takes places, and which brain circuits are involved in generating the pleasure we obtain from artistic practices, performances, and works. But it also suggests that pleasure is not the only effect of the arts. The evidence rather suggests that the arts have other cognitive and emotional effects which are closely related to human psychobiological health and well-being. These are: (1) attentional focus and flow, (2) affective experience, (3) emotion through imagery, (4) interpersonal communication, (5) self-intimation, and (6) social bonding. These effects are beneficial and contribute to the individual's biopsychological health and well-being. The fact that artistic practice has these effects helps explain why the arts are so important to human life, and why they developed in the first place, i.e., as ways to foster these effects. Therefore, a biopsychological science of the arts is emerging, according to which the arts can be conceptualized as an important system of external self-regulation, as a set of activities that contribute to our homeostasis and well-being.

Examining the artist-patient relationship in palliative care. A thematic analysis of artist reflections on encounters with palliative patients

BACKGROUND

Although therapeutic arts are used in the palliative care setting, little has been described about what happens during the artist-patient encounter and how these interactions can complement and integrate into the interdisciplinary model of palliative care. The objective of this study is to describe the artist-patient encounter and how artists can function in the palliative interdisciplinary model of care.

METHODS

Authors reviewed 229 reports written by artists about encounters with palliative patients, and performed thematic analysis on 95.

RESULTS

Artists describe physical, emotional and spiritual responses by patients including relaxation, invigoration and accessing spirituality, some of which were unique to the artist-patient interaction. Artists also described personal reactions including themes of professional fulfillment, kinship and empathy with patient suffering. Themes surrounding the artist-patient bond and trust also emerged.

CONCLUSIONS

The artist-patient encounter has an effect on both patients and artists, and can create a therapeutic relationship between them. Artists provide unique perspectives and contribute to care paradigms when integrated with  the palliative team.

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.

Critical reflections on methodological challenge in arts and dementia evaluation and research

Methodological rigour, or its absence, is often a focus of concern for the emerging field of evaluation and research around arts and dementia. However, this paper suggests that critical attention should also be paid to the way in which individual perceptions, hidden assumptions and underlying social and political structures influence methodological work in the field. Such attention will be particularly important for addressing methodological challenges relating to contextual variability, ethics, value judgement and signification identified through a literature review on this topic. Understanding how, where and when evaluators and researchers experience such challenges may help to identify fruitful approaches for future evaluation.

Not all about sex: neural and biobehavioral functions of human dance

This paper provides an integrative review of neuroscientific and biobehavioral evidence about the effects of dance on the individual across cultural differences. Dance moves us, and many derive aesthetic pleasure from it. However, in addition-and beyond aesthetics-we propose that dance has noteworthy, deeper neurobiological effects. We first summarize evidence that illustrates the centrality of dance to human life indirectly from archaeology, comparative psychology, developmental psychology, and cross-cultural psychology. Second, we review empirical evidence for six neural and biobehavioral functions of dance: (1) attentional focus/flow, (2) basic emotional experiences, (3) imagery, (4) communication, (5) self-intimation, and (6) social cohesion. We discuss the reviewed evidence in relation to current debates in the field of empirical enquiry into the functions of human dance, questioning the positions that dance is (1) just for pleasure, (2) all about sex, (3) just for mood management and well-being, and (4) for experts only. Being a young field, evidence is still piecemeal and inconclusive. This review aims to take a step toward a systematization of an emerging avenue of research: a neuro- and biobehavioral science of dance.

“Have you heard the one about…” using comedy to tackle mental health-related stigma with UK military personnel?

Purpose

The purpose of this paper is to provide first-hand reflections from a public mental health specialist, on developing an innovative comedy-based arts and health project that engaged with UK military personnel.

Design/methodology/approach

Project partners included the Academic Department of Military Mental Health at King’s College London and Army Headquarters. The project used a repeat measures design. The intervention group (IG) received a mental health-focussed comedy show and the control group received a standard comedy show. Serving Armed Forces personnel participated in focus groups to inform show scripts, which also contained key mental health messages agreed by the project team. Evaluation questionnaires were given out before and after the show and three months later.

Findings

The comedy show format proved to be an acceptable/popular way to present mental health-related messages. Post-show there was a statistically significant reduction in mental health stigmatisation and significantly better mental health and stigma-related knowledge in the IG.

Research limitations/implications

Due to deployment, follow-up participation was limited, reducing the ability to assess whether the effects were durable.

Practical implications

The challenges of working with serving personnel are outlined and some recommendations made to improve future comedy interventions/research with this group.

Originality/value

This study provides a thorough evaluation of an arts and health intervention using a comprehensive survey methodology.

A fuller picture: evaluating an art therapy programme in a multidisciplinary mental health service

Art therapy has a long history in mental healthcare, but requires an enhanced evidence base in order to better identify its precise role in contemporary services. This paper describes an evaluation of an art therapy programme in an acute adult psychiatry admission unit in Ireland. A mixed method research design was used. Quantitative data were collected through a survey of 35 staff members and 11 service users. Qualitative data included free text comments collected in the survey and individual feedback from service users. Both methods aimed to assess the role of art therapy as part of a multidisciplinary mental health service. Thematic content analysis was employed to analyse qualitative data. Staff demonstrated overwhelming support for art therapy as one element within multidisciplinary services available to patients in the acute psychiatry setting, Qualitative feedback associated art therapy with improvements in quality of life and individual support, and emphasised its role as a non-verbal intervention, especially useful for those who find talking therapy difficult. Creative self-expression is valued by staff and service users as part of the recovery process. Recommendations arising from the research include continuing the art therapy service, expanding it to include patients under rehabilitation, provision of information and education sessions to staff, and further research to identify other potential long-term effects. The low response of staff and small sample in this study, however, must be noted as limitations to these findings.

Necessidades de saúde e o cuidado de enfermagem

RESUMO Objetivo: apresentar os conceitos de necessidades em distintas vertentes para discutir a possibilidade de um atendimento que incorpore, no serviço de saúde, uma visão mais abrangente das vulnerabilidades humanas. Método: os argumentos se pautam em teoristas de enfermagem que trabalharam na construção de referenciais pertinentes ao cuidado fundamentado em necessidades e em filósofos que apresentam uma possibilidade de identificar vulnerabilidades do ser humano defendendo a arte como instrumento terapêutico que pode favorecer o cuidado à saúde. Conclusão: embora sob algumas perspectivas o cuidado possa adquirir uma nova dimensão com a introdução da arte, é necessário retomar os estudos filosóficos em ética e estética para identificar as vulnerabilidades humanas que possam, de fato, ser compensadas pela apreensão sensível do mundo exterior. Incorporar a arte ao cuidado de enfermagem requer resgatar os estudos de teoristas, aprofundar conceitos e trabalhar em investigações empíricas para seu uso adequado.

Using drawings to explore patients' perceptions of their illness: a scoping review

Background

An emerging approach for investigating patient perspectives of their illness is the use of drawings.

Objective

This scoping review consolidates findings from current literature regarding the use of drawings to explore patients’ perceptions and experiences of their illness and treatment.

Methods

Electronic databases (Medline, PubMed, Embase, PsychINFO, Cinahl, Art Index and Scopus) and reference lists were searched to identify published English language studies using participant-generated drawings to explore adults’ perceptions and experiences of their illness and treatment. Using the scoping methodological framework, data were analyzed with respect to each study’s design, key findings and implications.

Results

Thirty-two studies were identified and these reflected diversities in both health conditions and methods of data collection and analysis. Participants’ drawings revealed new, insightful knowledge about patients’ perceptions, beliefs and experiences of their condition and were associated with clinical and psychological markers of health. Drawing was a powerful adjunct to traditional data collection approaches, and demonstrated potential benefits for participants. This review provides detailed insights and guidance on the use of drawings in research and clinical practice.

Conclusion

Drawing is a novel and potentially valuable technique for exploring patients’ perceptions and experiences about their illness and treatment. Advancing the methodology and applicability of drawings in this area will assist in the future development of this technique, with benefits for the patient, researcher and health care professional alike.

What works for wellbeing in culture and sport? Report of a DELPHI process to support coproduction and establish principles and parameters of an evidence review

Aims:

There is a growing recognition of the ways in which culture and sport can contribute to wellbeing. A strong evidence base is needed to support innovative service development and a 3-year research programme is being undertaken to capture best evidence of wellbeing impacts and outcomes of cultural and sporting activities in order to inform UK policy and practice. This article provides an overview of methods and findings from an initial coproduction process with key stakeholders that sought to explore and agree principles and parameters of the evidence review for culture, sport and wellbeing (CSW).

Methods:

A two-stage DELPHI process was conducted with a purposeful sample of 57 stakeholders between August and December 2015. Participants were drawn from a range of culture and sport organisations and included commissioners and managers, policy makers, representatives of service delivery organisations (SDOs) and scholars. The DELPHI 1 questionnaire was developed from extensive consultation in July and August 2015. It explored definitions of wellbeing, the role of evidence, quality assessment, and the culture and sport populations, settings and interventions that are most likely to deliver wellbeing outcomes. Following further consultation, the results, presented as a series of ranked statements, were sent back to participants (DELPHI 2), which allowed them to reflect on and, if they wished, express agreement or disagreement with the emerging consensus.

Results:

A total of 40 stakeholders (70.02%) responded to the DELPHI questionnaires. DELPHI 1 mapped areas of agreement and disagreement, confirmed in DELPHI 2. The exercise drew together the key priorities for the CSW evidence review.

Conclusion:

The DELPHI process, in combination with face-to-face deliberation, enabled stakeholders to engage in complex discussion and express nuanced priorities while also allowing the group to come to an overall consensus and agree outcomes. The results will inform the CSW evidence review programme until its completion in March 2018.

Translating Knowledge

Introduction. Intergenerational programs have been touted to address the generation gaps and isolation of older adults. Mutual contact alone has produced mixed results, but attention to the intergenerational program content demonstrates well-being benefits. This practice-based article examines the benefits of creating and performing ensemble-created plays to older adults’ and university students’ well-being and the key processes that promote well-being. Method. This community participatory research project involved older adults as researchers as well as research subjects. Individual semistructured interviews were conducted by two trained interviewers with older adults (n = 15) and university students (n = 17). Results. Professional dramaturgical processes of storytelling, reminiscence, and playfulness were key elements in participants’ generative learning. They augmented older adults’ and university students’ ability to understand their situations and try innovative solutions. Skills such as openness, flexibility, and adaptation transferred into students’ and older adults’ daily lives. Conclusion. Participating in this intergenerational theatre group reduced ageism and improved intergenerational relationships. It increased older adults’ and university students’ well-being by building social networks, confidence, and self-esteem and developed a sense of social justice, empathy, and support for others.

Effects of Community Singing Program on Mental Health Outcomes of Australian Aboriginal and Torres Strait Islander People

Purpose:

To evaluate the impact of a meditative singing program on the health outcomes of Aboriginal and Torres Strait Islander people.

Design:

The study used a prospective intervention design.

Setting:

The study took place in six Aboriginal and Torres Strait Islander communities and Community Controlled Health Services in Queensland, Australia.

Subjects:

Study participants were 210 Australian Aboriginal and Torres Strait Islander adults aged 18 to 71 years, of which 108 were in a singing intervention group and 102 in a comparison group.

Intervention:

A participative community-based community singing program involving weekly singing rehearsals was conducted over an 18-month period.

Measures:

Standardized measures in depression, resilience, sense of connectedness, social support, and singing related quality of life were used.

Analysis:

The general linear model was used to compare differences pre- and postintervention on outcome variables, and structural equation modeling was used to examine the pathway of the intervention effect.

Results:

Results revealed a significant reduction in the proportion of adults in the singing group classified as depressed and a concomitant significant increase in resilience levels, quality of life, sense of connectedness, and social support among this group. There were no significant changes for these variables in the comparison group.

Conclusions:

The participatory community singing approach linked to preventative health services was associated with improved health, resilience, sense of connectedness, social support, and mental health status among Aboriginal and Torres Strait Islander adults.

Creating psychological connections between intervention recipients: development and focus group evaluation of a group singing session for people with aphasia

OBJECTIVES

The study sought to identify key design features that could be used to create a new framework for group-based health interventions. We designed and tested the first session of a group intervention for stroke survivors with aphasia which was aimed at nurturing new psychological connections between group members.

SETTING

The intervention session, a participant focus group and interviews with intervention facilitators were held in a local community music centre in the South West of England.

PARTICIPANTS

A convenience sample of 10 community-dwelling people with poststroke aphasia participated in the session. Severity of aphasia was not considered for inclusion.

INTERVENTION

Participants took part in a 90-min group singing session which involved singing songs from a specially prepared song book. Musical accompaniment was provided by the facilitators.

PRIMARY AND SECONDARY OUTCOME MEASURES

Participants and group facilitators reported their experiences of participating in the session, with a focus on activities within the session related to the intervention aims. Researcher observations of the session were also made.

RESULTS

Two themes emerged from the analysis, concerning experiences of the session ('developing a sense of group belonging') and perceptions of its design and delivery ('creating the conditions for engagement'). Participants described an emerging sense of shared social identity as a member of the intervention group and identified fixed (eg, group size, session breaks) and flexible (eg, facilitator responsiveness) features of the session which contributed to this emergence. Facilitator interviews and researcher observations corroborated and expanded participant reports.

CONCLUSIONS

Engagement with health intervention content may be enhanced in group settings when intervention participants begin to establish positive and meaningful psychological connections with other group members. Understanding and actively nurturing these connections should be a core feature of a general framework for the design and delivery of group interventions.