Ranjita Dhital

Aim: Public health professionals need evidence-based education to equip them with sufficient knowledge to recommend creative community programmes and arts therapies. The current review asks ‘What is known about how visual arts, performing arts, and creative writing are embedded in health and medical education?’. Method: A search across six different databases (CINAHL, ERIC, Medline, AMED, ProQuest Dissertations, and Web of Science) identified 6090 articles, and 284 were included. The core search terms were (1) Visual arts; performance arts and creative writing, (2) Tertiary education and health Professionals. Descriptive statistics were used to quantify the characteristics of learning activities. Thematic analysis was used to identify the intended learning outcomes. Results: Nursing was the most represented profession, followed closely by medicine. An extremely wide range of art practices were identified, including graffiti, sculpture, clowning, cinematic arts, music, creative writing, poetry, dance, photo, and art viewing. The review characterises how visual arts, performing arts, and creative writing are currently being used, including the group size, setting, engagement style, and collaboration with creative practitioners. Surprisingly, only 10% of studies focussed on creative arts therapies, arts-based interventions or community arts, and no mention of social prescribing was identified. Instead, the majority of studies focussed on visual and performing arts as pedagogical tools, and the main learning outcomes were professional development (promoting empathy, communication, preparedness for practice, negative attitudes), clinical practice (critical thinking, specialist knowledge, clinical skills), and personal development (self-awareness, well-being). Conclusion: This review highlights that visual and performing arts are used as pedagogical tools across a range of professions, and the need for more patient-centred educational provision in creative arts therapies, arts-based interventions, and community arts. Future curricula could engage arts practitioners and cultural spaces more directly to support experiential learning approaches and evaluate creative techniques to identify if they can enhance student learning.

Alcohol has complex, historic, and deep cultural significance in Nepal. Countries from the global majority, such as Nepal, experience the highest burden of harm from alcohol with increasing consumption rates compared with high-income countries. Therefore, alcohol harm reduction initiatives that engage meaningfully with cultural and community practices are needed. The Alcohol Co-design and Community Engagement (ACE) study aimed to co-create new understanding of harmful use of alcohol through applying creative and participatory approaches to inform future alcohol research and policy in Nepal. This article reports on the creative methodological process used to co-create knowledge exchange with diverse communities, co-researchers, and policy makers in Nepal. We co-produced a range of creative alcohol policy review activities, including scoping community and cultural assets that could be harnessed to reduce harmful use of alcohol by working with communities, including those with lived experience. This allowed us to understand the nature of any existing health and community support available locally, while highlighting the absence of much-needed support. We achieved this through using multi-modal, participatory approaches to critically review current policy and explored other forms of knowledge – centring indigenous knowledge – for its cultural and contextual relevance to reduce harmful use of alcohol and make recommendations for alcohol research and policy development and implementation in Nepal.

AIM: Public health professionals need evidence-based education to equip them with sufficient knowledge to recommend creative community programmes and arts therapies. The current review asks ‘What is known about how visual arts, performing arts, and creative writing are embedded in health and medical education?’.METHOD: A search across six different databases [CINAHL, ERIC, Medline, AMED, Proquest Dissertations, and Web of Science] identified 6090 papers, and 284 were included. The core search terms were 1. Visual arts; performance arts and creative writing 2. Tertiary education and 3.Health Professionals. Descriptive statistics were used to quantify the characteristics learning activities. Thematic analysis was used to identify the intended learning outcomes.RESULTS: Nursing was the most represented profession, followed closely by medicine. An extremely wide range of art practices were identified including graffiti, sculpture, clowning, cinematic arts, music, creative writing, poetry, dance, photo, and art viewing. The review characterises how visual arts, performing arts, and creative writing are currently being used, including the group size, setting, engagement style, and collaboration with creative practitioners. Surprisingly, only 10% of studies identified educated professionals on the evidence base underpinning creative interventions and therapies, and no mention of social prescribing was identified. Instead the main learning outcomes that were targeted were professional development (promoting empathy, communication, preparedness for practice, negative attitudes), clinical practice (critical thinking, specialist knowledge, clinical skills), and personal development (self-awareness, wellbeing).CONCLUSION: This review highlights the need for more educational provision in relation to patient-focussed outcomes, in community arts, creative arts therapies, and social prescribing. Future curricula could engage arts practitioners and cultural spaces more directly to support experiential learning approaches and evaluate creative techniques to identify if they can enhance student learning.

Background: Acamprosate is an effective and cost-effective medication for alcohol relapse prevention but poor adherence can limit its full benefit. Effective interventions to support adherence to acamprosate are therefore needed. Objectives: To determine the effectiveness of Medication Management, with and without Contingency Management, compared to Standard Support alone in enhancing adherence to acamprosate and the impact of adherence to acamprosate on abstinence and reduced alcohol consumption. Design: Multicentre, three-arm, parallel-group, randomised controlled clinical trial. Setting: Specialist alcohol treatment services in five regions of England (South East London, Central and North West London, Wessex, Yorkshire and Humber and West Midlands). Participants: Adults (aged 18 years or more), an International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis of alcohol dependence, abstinent from alcohol at baseline assessment, in receipt of a prescription for acamprosate. Interventions: (1) Standard Support, (2) Standard Support with adjunctive Medication Management provided by pharmacists via a clinical contact centre (12 sessions over 6 months), (3) Standard Support with adjunctive Medication Management plus Contingency Management that consisted of vouchers (up to £120) to reinforce participation in Medication Management. Consenting participants were randomised in a 2 : 1 : 1 ratio to one of the three groups using a stratified random permuted block method using a remote system. Participants and researchers were not blind to treatment allocation. Main outcome measures: Primary outcome: self-reported percentage of medication taken in the previous 28 days at 6 months post randomisation. Economic outcome: EuroQol-5 Dimensions, a five-level version, used to calculate quality-adjusted life-years, with costs estimated using the Adult Service Use Schedule. Results: Of the 1459 potential participants approached, 1019 (70%) were assessed and 739 (73 consented to participate in the study, 372 (50%) were allocated to Standard Support, 182 (25%) to Standard Support with Medication Management and 185 (25%) to Standard Support and Medication Management with Contingency Management. Data were available for 518 (70%) of participants at 6-month follow-up, 255 (68.5%) allocated to Standard Support, 122 (67.0%) to Standard Support and Medication Management and 141 (76.2%) to Standard Support and Medication Management with Contingency Management. The mean difference of per cent adherence to acamprosate was higher for those who received Standard Support and Medication Management with Contingency Management (10.6%, 95% confidence interval 19.6% to 1.6%) compared to Standard Support alone, at the primary end point (6-month follow-up). There was no significant difference in per cent days adherent when comparing Standard Support and Medication Management with Standard Support alone 3.1% (95% confidence interval 12.8% to −6.5%) or comparing Standard Support and Medication Management with Standard Support and Medication Management with Contingency Management 7.9% (95% confidence interval 18.7% to −2.8%). The primary economic analysis at 6 months found that Standard Support and Medication Management with Contingency Management was cost-effective compared to Standard Support alone, achieving small gains in quality-adjusted life-years at a lower cost per participant. Cost-effectiveness was not observed for adjunctive Medication Management compared to Standard Support alone. There were no serious adverse events related to the trial interventions reported. Limitations: The trial’s primary outcome measure changed substantially due to data collection difficulties and therefore relied on a measure of self-reported adherence. A lower than anticipated follow-up rate at 12 months may have lowered the statistical power to detect differences in the secondary analyses, although the primary analysis was not impacted. Conclusions: Medication Management enhanced with Contingency Management is beneficial to patients for supporting them to take acamprosate. Future work: Given our findings in relation to Contingency Management enhancing Medication Management adherence, future trials should be developed to explore its effectiveness and cost-effectiveness with other alcohol interventions where there is evidence of poor adherence. Trial registration: This trial is registered as ISRCTN17083622 https://doi.org/10.1186/ISRCTN17083622. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 22. See the NIHR Journals Library website for further project information.

Aims: To scope the breadth of existing cultural and community assets and how alcohol drinkers and community health workers perceived them in relation to reducing alcohol-related harm. Methods: The study was conducted in Chitwan, south-central Nepal, which has considerable alcohol problems. Participatory asset mapping was conducted using field notes, photography, and through engaging with communities to explore how community assets affect alcohol consumption. Semi-structured photovoice interviews were conducted with harmful/hazardous drinkers (AUDIT score 8 to 19) and community health workers. Purposive and snowball sampling were used to recruit participants. During interviews, participants used their photographs to reflect on how community assets influenced alcohol use. Thematic framework analysis was used to analyse the data. Results: We recruited 12 harmful/hazardous drinkers (3 females) and 6 health workers (2 females). The mean AUDIT score of the former was 12.17 (SD ±2.86). Thematic analysis of the photovoice interviews produced three themes: ‘influences and impact of families and communities’; ‘culture and spirituality’; and ‘nature and the environment’. The community mapping produced five assets that promoted alcohol consumption: (1) availability; (2) advertising; (3) negative attitudes towards users; (4) festivals/gatherings; and (5) illiteracy/poverty. Six assets that discouraged consumption were: (1) legislation restricting use; (2) community organisations; (3) cultural/spiritual sites; (4) healthcare facilities; (5) family and communities; and (6) women’s community groups. Those from certain ethnic groups consumed more alcohol, experienced more family discord, or felt stigmatised due to their drinking. Assets ‘festivals/gatherings’ and ‘negative attitudes toward users’ and the theme ‘family and communities’ concerned with relationships and community activities were perceived to both promote and reduce alcohol use. Conclusions: This study provides new insight into a variety of cultural and community assets that promote and reduce alcohol use. The study identifies new possibilities to build on visual participatory and arts-based methods that have potential to be effectively implemented at scale.

Ranjita Dhital, Rachel Coleman, Ed Day, Colin Drummond, Anne Lingford-Hughes, John Marsden, Tom Phillips, Julia Sinclair, John Strang, John Weinman, Cate Whittlesea, Kideshini Widyaratna, Kim Donoghue, Service Users’ Views and Experiences of Alcohol Relapse Prevention Treatment and Adherence: New Role for Pharmacists?, Alcohol and Alcoholism, 2022;, agac011, https://doi.org/10.1093/alcalc/agac011

Aims: To understand service users' views and experiences of alcohol relapse prevention medication, views of a telephone behavioural modification intervention delivered by pharmacists and the use of Contingency Management (CM) to support acamprosate adherence following assisted alcohol withdrawal. Methods: Four focus groups were conducted within four alcohol treatment and recovery groups across England (UK), with service users with lived experience of alcohol dependence (26 participants). Semi-structured topic guide was used to explore participants' views and experiences of alcohol relapse prevention medication, a telephone behavioural modification medication intervention delivered by pharmacists, and the use of CM to support acamprosate adherence. These were audio-recorded, transcribed verbatim and thematically analysed inductively and deductively. Results: Four themes were identified: concerns about support and availability of alcohol relapse prevention medication; lack of knowledge and understanding about acamprosate treatment; positive perceptions of acamprosate adherence telephone support from pharmacists; and negative perceptions of CM to support acamprosate adherence. There were misunderstandings about acamprosate's mode of action and strong negative beliefs about CM. However, most were positive about pharmacists' new role to support acamprosate adherence. Conclusion: This study highlighted challenges service users face to commence alcohol relapse prevention medication. It appears service users could benefit from a pharmacist-led telephone intervention to improve understanding about acamprosate medication, particularly, if delivered in an engaging and motivating way.

Aim: This systematic review aimed to provide new insights into how pharmacy spaces, or the architecture of pharmacies, are experienced by pharmacy service users and staff. The review sought to identify environmental factors which may influence service users’ and staff participation in community-based pharmacy health services. Method: Ten databases were searched for English language publications, using a combination of search terms relating to pharmacy service users and staff; pharmacy spaces; and health and social care outcomes. Data from the final selected studies were extracted, thematically analysed using a narrative approach and the quality of each study assessed using the Integrated quality Criteria for the Review of Multiple Study designs (ICROMS). Results: 80 articles reporting 80 studies published between 1994 and 2020 were identified; they were from 28 countries, involving around 3234 community pharmacies, 13,615 pharmacy service users, 5056 pharmacists and 78 pharmacy health staff. Most studies (94%) met the ICROMS minimum score, and half did not meet the mandatory quality criteria. Four themes likely to influence service users’ and staff experiences of pharmacy health services were identified: (1) privacy; (2) experience of the physical environment; (3) professional image; and (4) risk of error. Conclusion: To optimise the delivery and experience of pharmacy health services, these spaces should be made more engaging. Future applied research could focus on optimising inclusive pharmacy design features.