What are the active ingredients of ‘arts in health’ activities? Development of the INgredients iN ArTs in hEalth (INNATE) Framework

Background: There is a scarcity of research concerning what it is about arts engagement that may activate causal mechanisms leading to effects on health and wellbeing outcomes: their active ingredients. Further, the limited studies that do exist have tended to be relevant to specific contexts and types of art forms. The aim of this study was to carry out a comprehensive mapping of potential active ingredients, construct a shared language, and propose a framework and toolkit to support the design, implementation, and evaluation of arts in health activities. Methods: Drawing upon Rapid Appraisal techniques and collaborating with 64 participants, we engaged in a three-phase process: 1) a scoping review to inform the development of an initial framework; 2) consultation on the initial framework; and 3) analysis and construction of the INNATE framework. Results: The study identified 139 potential active ingredients within the overarching categories of project, people, and contexts. Project components relate directly to the content of the arts activity itself, intrinsic to what the activity is. The people category denotes how people interact through engagement with the activity and who is involved in this interaction, including activity facilitation. Contexts relates to the activity setting comprising the aggregate of place(s), things, and surroundings. Aligning with complexity science, Ingredients may overlap, interconnect, or feed into one another to prompt mechanisms, and may not be experienced as distinct by participants. Conclusions: Our mapping exercise is the most extensive to date. In relation to arts in health activities, the INNATE framework can support with: design and implementation, such as co-producing an intervention to meet the needs of a particular population; evaluation, such as facilitating the comparison of different interventions and their efficacy; and replication, scalability, and sustainability through enabling detailed reporting and specific articulation of what an arts in health activity entails.

Enstranglements: Performing Within, and Exiting From, the Arts-in-Health “Setting”

The following text explores performative art works commissioned within a specific “arts and health” cultural setting, namely that of a medical school within a British university. It examines the degree to which the professional autonomy of the artists (and curator) was “instrumentalized” and diminished as a result of having to fit into normative frames set by institutional agendas (in this case, that of “the neoliberal university”). We ask to what extent do such “entanglements,” feel more like “enstranglements,” suffocating the artist’s capacity to envision the world afresh or any differently? What kinds of pressures allow for certain kinds of “evidence” to be read and made visible, (and not others)? Are You Feeling Better? was a 2016 programme curated by Frances Williams, challenging simplistic expectations that the arts hold any automatic power of their own to make “things better” in healthcare. It included two performative projects – The Secret Society of Imperfect Nurses, by Anthony Schrag with student nurses at Kings College London, and Hiding in Plain Sight by Becky Shaw (plus film with Rose Butler) with doctoral researchers in nursing and midwifery. These projects were situated in a climate of United Kingdom National Health Service cuts and austerity measures where the advancement of social prescribing looks dangerously like the government abnegating responsibility and offering art as amelioration. The text therefore examines the critical “stage” on which these arts-health projects were performed and the extent to which critical reflection is welcomed within institutional contexts, how learning is framed, expressed aesthetically, as well as understood as art practice (as much as “education” or “learning”). It further examines how artistic projects might offer sites of resistance, rejection and mechanisms of support against constricting institutional norms and practices that seek to instrumentalise artistic works to their own ends.

A hospital’s collaborative arts in health approach to COVID-19

This note from the field outlines how an integrated arts in health department within a hospital created clinical and non-clinical art experiences for patients and providers during COVID-19. Working with a multi-disciplinary team, the Center for Performing Arts Medicine at Houston Methodist established creative arts therapy and arts integration programmes targeting patient and provider experiences during COVID-19. Emphasis is placed on how programmes respond to both physical health and emotional well-being through accessible, appropriate art experiences. This article outlines those strategies and highlights various entry points for arts experiences in a hospital experience during a pandemic.

What are the active ingredients of ‘arts in health’ activities? Development of the INgredients iN ArTs in hEalth (INNATE) Framework

Background: There is a scarcity of research concerning what it is about arts engagement that may activate causal mechanisms leading to effects on health and wellbeing outcomes: their active ingredients. Further, the limited studies that do exist have tended to be relevant to specific contexts and types of art forms. The aim of this study was to carry out a comprehensive mapping of potential active ingredients, construct a shared language, and propose a framework and toolkit to support the design, implementation, and evaluation of arts in health activities.Methods: Drawing upon Rapid Appraisal techniques and collaborating with 64 participants, we engaged in a three-phase process: 1) a scoping review to inform the development of an initial framework; 2) a consultation on the initial framework; and 3) analysis of consultation responses and construction of the INNATE framework. Results: The study identified 139 potential active ingredients within the overarching categories of project, people, and contexts. Project components relate directly to the content of the arts activity itself, intrinsic to what the activity is. The people category denotes how people interact through engagement with the activity and who is involved in this interaction, including activity facilitation. Contexts relates to the activity setting comprising the aggregate of place(s), things, and surroundings. Aligning with complexity science, ingredients may overlap, interconnect, or feed into one another to prompt mechanisms, and may not be experienced as distinct by participants. Conclusions: Our mapping exercise is the most extensive to date. In relation to arts in health activities, the INNATE framework can support with: design and implementation, such as in co-producing an intervention to meet the needs of a particular population; evaluation, such as facilitating the comparison of different interventions and their efficacy; and replication, scalability, and sustainability through enabling detailed reporting and specific articulation of what an arts in health activity entails. The toolkit can also be used as a reflexive tool to support those delivering arts in health activities.

Drum Circles and the Effect on Wellbeing in a Community Setting

Background: Wellbeing plays an essential role in a complete and health community. Participatory arts interventions are popular to address wellbeing. Participatory drum circles can lead to social resilience, emotional completeness, and mental health benefits. The literature in the field of arts in health demonstrate the specific ways a drum circle may affect wellbeing through socialization, rhythmic entrainment, and expression. Although there are many great resources, many lack the specific tools to facilitate a drum circles as it pertains to specific technique and styles often utilized in percussion in the field of arts in health. Methods: The project used a mixed methods research design. A convergent mixed methods design will be used to collect quantitative data from the Warwick Edinburgh Mental Wellbeing Scale and the qualitative data will be received from a focus group. The results will be compared with the hopes of yielding similar themes. Results: The results of the Warwick Edinburgh Mental Wellbeing scale demonstrate an increase of the average wellbeing score after the four-week intervention by 2.88 points. The focus group’s final themes were 1) the core of the drum circle is driven from the facilitator fostering a strong sense of community that supports being inclusionary, respectful, and social; 2) Learning new skills in a community group benefits participants confidence because a) the curriculum progresses naturally and easily and b) rhythm is an innate and natural part of everyday life for individuals, making drum circles more comfortable.

Development of a complex arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis

Background Patients with end-stage kidney disease who receive haemodialysis experience a protracted treatment regimen that can result in an increased risk of depression and anxiety. Arts-based interventions could address this unique issue; however, no arts-based interventions have been developed for delivery within a haemodialysis unit and evaluation within a randomised controlled trials (RCTs). Aim To develop a complex arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis. Methods The development process utilised the Arts in Health framework (Fancourt, 2017). The framework was addressed through the establishment of an interdisciplinary advisory group, collaboration and consultation with stakeholders, a scoping and realist review, shadowing of artists-in-residence, personal arts practice and logic modelling. Results The intervention involved six 1-h long, one-to-one facilitated sessions focused on creative writing and visual art. Patients could choose between art form and self-select a subject matter. The sessions had a primary focus on skill development and were delivered using principles derived from the psychological theory of flow. Conclusion The Arts in Health framework provided an appropriate and pragmatic approach to intervention development. Complex arts-based interventions can be developed for the purpose of evaluation within a trial framework. This intervention was designed to strike a balance between standardised components, and a person-centred approach necessary to address existential boredom.

Towards the social prescription of the arts: The arts in health and social care in Malta

Recently, the notion of arts as therapy has been of growing interest to sociologists. The aim of this article is to evaluate community-based arts funded projects in terms of their priorities and effectiveness and discuss possibilities for enabling Arts on Prescription schemes in Malta. Thematically, this article explores discourse on the potential of the arts on promoting well-being. Methodologically, this article draws on primary data collected from focus groups, interviews and an online survey with project leaders and artists of funded arts projects targeting mental health, disability or old age. Specifically, this research evaluates all national funded community-based arts projects in Malta between 2014 to 2018 under a national scheme of the President’s Award for Creativity fund, managed by the national Arts Council Malta. Analysis of this data was used to inform the new national cultural policy on the implantation of the Arts on Prescription scheme in Malta.

‘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.