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.

Who engaged in home-based arts activities during the COVID-19 pandemic? A cross-sectional analysis of data from 4,731 adults in the United States

Arts engagement is a health-related behavior that may be influenced by social inequalities. While the COVID-19 pandemic provided new opportunities for some people to engage in the arts, it might have created barriers for others. We aimed to examine whether there was social patterning in home-based arts engagement during the pandemic in the United States (US), and whether predictors of engagement differed according to the type of arts activity. We included 4,731 adults who participated in the US COVID-19 Social Study between April and July 2020. Three types of home-based arts engagement were considered: reading for pleasure, arts or crafts activities, and digital arts activities. Using logistic regression models, we tested cross-sectional associations between a broad range of demographic, socioeconomic, psychosocial, and health-related factors as well as adverse events and worries during lockdown and each type of arts engagement. The factors most strongly associated with all three types of arts engagement were social support, social network size, age, race/ethnicity, keyworker status, and experiencing physical or psychological abuse during the pandemic. However, most socioeconomic and health-related factors were not associated with arts engagement, including household income and mental and physical health problems. Overall, our findings indicate that the social gradient in arts engagement was reduced in the first four months of the COVID-19 pandemic in the US. Given the health benefits of arts engagement, the potential diversification of arts audiences during the pandemic is promising for both population-level health and wellbeing and the future of the arts and cultural sector.

Difference in predictors and barriers to arts and cultural engagement with age in the United States: A cross-sectional analysis using the Health and Retirement Study

Introduction Arts and cultural engagement are associated with a range of mental and physical health benefits, including promoting heathy aging and lower incidence of age-related disabilities such as slower cognitive decline and slower progression of frailty. This suggests arts engagement constitutes health-promoting behaviour in older age. However, there are no large-scale studies examining how the predictors of arts engagement vary with age. Methods Data from the Health and Retirement Study (2014) were used to identify sociodemographic, life satisfaction, social, and arts appreciation predictors of (1) frequency of arts engagement, (2) cultural attendance, (3) difficulty participating in the arts, and (4) being an interested non-attendee of cultural events. Logistic regression models were stratified by age groups [50–59, 60–69, ≥70] for the frequency of arts participation outcome and [50–69 vs ≥70] all other outcomes. Results Findings indicated a number of age-related predictors of frequent arts engagement, including gender, educational attainment, wealth, dissatisfaction with aging, and instrumental activities of daily living (iADL). For cultural event attendance, lower interest in the arts predicted lack of engagement across age groups, whereas higher educational attainment and more frequent religious service attendance became predictors in older age groups (≥ 70). Adults in both age groups were less likely to report difficulties engaging in the arts if they had lower neighbourhood safety, whilst poor self-rated health and low arts appreciation also predicted reduced likelihood of this outcome, but only in the younger (50–69) age group. Adults in the older (≥ 70) age group were more likely to be interested non-attendees of cultural events if they had higher educational attainment and less likely if they lived in neighbourhoods with low levels of safety. Conclusions Our results suggest that certain factors become stronger predictors of arts and cultural engagement and barriers to engagement as people age. Further, there appear to be socioeconomic inequalities in engagement that may increase in older ages, with arts activities overall more accessible as individuals age compared to cultural engagement due to additional financial barriers and transportation barriers. Ensuring that these activities are accessible to people of all ages will allow older adults to benefit from the range of health outcomes gained from arts and cultural engagement.

Dance and Music for Improving Health among Patients with Breast Cancer and Parkinson’s Disease: A Narrative Review

Although a longer life may bring new opportunities for older people and society, advancing age is a leading risk factor for developing several chronic diseases, consequently limiting the health span. During the ageing process, changes in the activity of several endocrine glands may occur, leading to different clinical conditions. Being physically active becomes fundamental for healthy ageing. Despite regular physical activity being shown to have many health benefits, patients with cancer and neurodegenerative diseases remain physically inactive. Over the past two decades, there has been a major increase in arts engagement (e.g., dance and music) on health and well-being in both clinical and non-clinical contexts. Dance and music have been shown to induce positive effects on hormonal glands, patients’ sociality, and self-confidence. Therefore, this review aims to highlight evidence regarding the effects of music and dance on hormonal responses and as preventive and compliance tools for heathy ageing in breast cancer and Parkinson’s disease patients.

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.

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.

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 practiceDesign: 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.

Associations between extracurricular arts activities, school-based arts engagement, and subsequent externalising behaviours: Findings from the Early Childhood Longitudinal Study

Introduction: Externalising behaviours during adolescence are associated with numerous long-term negative outcomes, although the majority of research is intervention-based as opposed to focused on risk reduction. Arts engagement has been associated with numerous beneficial factors linked to externalising behaviours, yet direct evidence linking them in longitudinal studies is lacking. Methods: Data from the Early Childhood Longitudinal Study were used, with baseline taken at 5th grade (aged 10-11 years) and outcomes measured at 8th grade (13-14 years). Ordinary least squares regression was used to examine individual-level associations between extracurricular and school-based arts engagement (number arts classes and adequacy of arts facilities) with externalising behaviours measured using the Strengths and Difficulties Questionnaire. Poisson regression was used to examine associations between school-level arts classes and facilities with an administrator-reported index of externalising behaviours in the school. All models were adjusted for sociodemographic factors. Individual-level analyses were clustered by school.Results: At the individual level, engaging in a greater number of extracurricular arts activities in 5th grade was associated with fewer externalising behaviours in 8th grade, although there was no association for school-based arts engagement. There were no school-level associations between arts classes or adequate arts facilities and externalising behaviours. Conclusions: Our results suggest extracurricular arts activities may be beneficial in reducing the risk for externalising behaviours, but the relationship is seen at an individual-level of engagement rather than based on school-level provision or facilities. Ensuring extracurricular access to the arts should be considered as a cost-effective way of preventing externalising behaviours while simultaneously promoting healthy emotional, coping, and social behaviours.

Associations between neighbourhood deprivation and engagement in arts, culture and heritage: evidence from two nationally-representative samples

Background Previous research has shown the benefits of arts and cultural engagement for physical, mental and social wellbeing. This engagement is socially and geographically patterned. Yet it remains unclear whether place-based attributes are associated with engagement behaviour independent of individual factors. Therefore, the aim of this cross-sectional study was to robustly disentangle associations between geographical deprivation and arts engagement from the individual socio-demographic factors that tend to correlate with residential locations. Methods Two different samples drawn from two representative surveys of adults living in England were compared – Understanding Society Wave 2 (2010/12) (N = 14,782) and Taking Part survey (2010/11) (N = 4575). Propensity score matching (PSM) was applied to investigate the association between neighbourhood deprivation (20% most deprived vs 20% least deprived) and arts engagement (arts participation, cultural attendance and museums and heritage engagement). Results Higher levels of neighbourhood deprivation were associated with lower arts, culture and heritage engagement independent of individuals’ demographic backgrounds, socio-economic characteristics and regional locations. When exploring subcategories of deprivation, similar results were obtained across deprivation domains. Results were also consistent when using more distinct categories of deprivation (i.e. 10% most deprived vs 10% least deprived) and when comparing people living in the 20% most deprived neighbourhoods with those living in the 40% medium-deprived areas. Conclusion This study is the first to apply a robust PSM technique to examine the association between neighbourhood deprivation and arts engagement using two nationally-representative samples. Results show that neighbourhood deprivation may act as a barrier that could prevent people from engaging in the arts, which in turn may exacerbate social and health inequalities. This highlights the importance of place-based schemes that focus on increasing individual motivation and capacity to engage in arts and cultural activities, especially in areas of high deprivation.