Anita Jensen

Aims: Using a longitudinal approach, the aim of this study was to examine whether baseline engagement in arts and culture was associated with a decline from ‘Good’ to ‘Poor’ health at follow-up. Methods: Self-rated health (SRH) and engagement in six cultural activities among randomly selected Danish adults (⩾15 years) were assessed using data from the Danish Health and Wellbeing Survey in 2019. One year later, all individuals were invited to complete a follow-up survey questionnaire. SRH was dichotomised into ‘Good’ (very good/good) and ‘Poor’ (fair/bad/very bad). The cultural participation index (CPI) was used to measure engagement in arts and culture activities. Each activity was scored from 0 (never) to 4 (at least once a week). The total score across all activities could reach a maximum of 24. Adjusted logistic regression models assessed associations between cultural participation and poor health at 1-year follow-up. Results: The present study included 3286 individuals who perceived their health as good at baseline who completed both survey waves; 11.2% reported poor health at follow-up. Individuals who attended concerts and musical events at least once every 3 months were less likely to report poor health at follow-up (adjusted odds ratio (OR): 0.50, 95% confidence interval (CI): 0.35–0.71) than individuals who never attend concerts and musical events. Furthermore, a 1-point-higher CPI score was associated with a 0.96 (95% CI: 0.93–0.99) lower (adjusted) OR of reporting poor health at follow-up. Conclusions : This follow-up study extends our understanding of the positive health outcomes from engagement in arts and culture activities.

Opinion Apples and oranges? The importance of recognising heterogeneity in Arts and Health research publications Introduction Policymakers and practitioners often do not engage directly with academic research articles. Therefore, researchers must disseminate findings coherently and objectively. This includes transparent communication of the limitations of research and acknowledgement of diverse cultural contexts and factors. Recognising the challenges related to applicability across different environments is essential, as a one-size-fits-all approach is rarely effective. In the field of arts and health, we encounter research studies making generic claims that arts engagement is beneficial for health and wellbeing. While measuring tools are described as part of the methodology, the studies often lack descriptions of specifically how, and which, arts discipline(s) are involved. Important aspects of the facilitation, context, access to activities and choices for participants are under-reported and under-researched (1). For example, Arts on Prescription (AoP) programmes often consist of various arts and culture activities combined with different options for participation (active vs receptive). However, little is known about the content and delivery of the activities (2). Programmes are described as "arts for wellbeing", "arts for health" or "arts and recovery", without descriptions of the activities offered. Some reviews have also grouped together the arts as one classification (see: Fancourt & Finn (3) Curtis et al. (4) Jensen & Bonde (5)) and make claims of impact and effectiveness although the diagnoses of participants are also often unclear. Emphasising that the arts are good for one's health, is as imprecise as stating 'medicine' is good for your health. By using generic terms, we risk comparing apples with oranges. We argue that detailing the actual arts activities (and facilitation) used in research studies, is imperative. What is meant by 'the arts'? Disciplinary differences Arts and health researchers are drawn from a broad spectrum of academic disciplines. Within the published literature they rarely define 'arts' consistently, making comparison across these works, and knowledge synthesis, problematic (6). This reflects the long debate about what the 'arts' in 'arts and health' incorporates, compounded by differences across countries. For example, most pre-industrial societies do not have an independent overall concept of 'art', even though the population may engage in activities that those living in industrial societies may describe as the 'arts' such as singing, painting and dancing (7). Similarly, in many non-Anglo-Saxon cultures (ranging from Indigenous communities in the Americas to classical traditions in Asia and Africa) creative expression is often inseparable from spirituality, ritual, or community life, reminding us that the Western category of "art" represents only one cultural framework rather than a universal standard (8). Exploring the terminology used from an educational perspective, Sonke et al.(9) posit that the use of the 'arts' as plural indicates inclusion of visual, performing and literary arts, whereas the use of the singular 'art' indicates only the visual arts. The term 'creative arts' is also used which Sonke et al. suggests adopts a hierarchical view – the 'fine arts' versus 'creative arts' or 'crafts'. Currently, the 'arts' may be defined by genre or sector, (non-profit, commercial or government), where the activity takes place (e.g., community arts), whether they are undertaken alone or with others in a group (e.g., participatory arts), the mode of participation, active art-making, volunteering or audience participation, and whether they are live, recorded or on-line (10). Parkinson (11) uses the term the 'arts' to encompass everything, including the skills of the artist to the passion of the amateur, creativity, culture, and heritage. It may not be a problem for researchers to use 'the arts' as a metonym for all the activities which may be considered under the umbrella term 'arts', except when reporting research findings where it is crucial that for clarity and consistency the reader knows specifically which of the different art forms are the subject of the research. The use of different terms: "the arts for wellbeing", "arts for health" or "arts and recovery" There is also a lack of consensus regarding the appropriate way to categorise the arts practices which impact on human, health, and wellbeing. The arts and health field is diverse, incorporating many different art forms and practices, in a range of healthcare, community and educational settings, which may be designed for specific health issues and used as primary, secondary and tertiary interventions. Parkinson (11) describes this as a 'rich messy ecology', preoccupied with humanising clinical environments, targeting specific health outcomes and promoting cultural participation. Previously, White (12) identified five subtle permutations of terminology; 'arts in health', 'arts for health', 'arts into health', 'arts and health', and 'healing arts', each with different emphases, different approaches and different beliefs about health, ill-health and the place of arts practise in promoting health (and based on different epistemological underpinnings including biomedical, behavioural, community-based and social models). Fancourt (13) speculated that the phrase 'arts and health' suggests that they are given equal weight (a common perspective in community-based models), whereas 'arts in health' suggests that the arts are a way of supporting health in healthcare systems (sometimes associated with a biomedical perspective). The use of arts activities as interventions in healthcare may result in 'arts and health' being governed by the health services and being reconceptualized as therapy or treatment (14). This then leads to yet another categorisation, 'arts as treatment' which is typically...

Background: Primary healthcare providers are increasingly challenged in supporting patients with psychosocial needs. Arts on Prescription (AoP) has been shown to improve primary healthcare patients’ mental health wellbeing. The aim of the current study is to understand the psychosocial effect of participating in an Arts on Prescription programme. Methods: A total of 112 primary healthcare patients from 18 primary healthcare centres in Scania with mental health diagnoses depression and anxiety or social isolation participated in a 10-week group-based arts programme, twice a week for 2 h. A questionnaire with the Short Warwick Edinburgh Mental Wellbeing Scale (SWEMWBS), the Salutogenic Health Indicator Scale (SHIS) (for baseline and follow-up) and 14 sociodemographic and self-rated health covariates were collected as baseline. We also conducted 28 semi-structured interviews. We analysed data using paired t-test and a general linear regression model for change in SWEMWBS and SHIS. Qualitative data was analysed using a thematic approach. Results: The paired t-test showed highly significant results (p < 0.001) for increase in both SWEMWBS and SHIS. The general linear regression. models show that women and participants with poorer self-rated health (SRH), more contacts with the healthcare system, other referrals from the primary healthcare centre, and no previous arts and culture engagement displayed significantly stronger associations with increase in SWEMWBS but not SHIS. Qualitative results highlight use of other interventions and difficulties navigating the health system. Conclusions: Our findings support a proportionate universalism (scale and intensity proportionate to the degree of need) approach indicating that AoP programmes could be valuable additions to healthcare pathways enhancing wellbeing for vulnerable populations. Findings should be interpreted with caution due to small sample size.

Background: Mental health problems are an increasing challenge for primary healthcare. It puts strain on the healthcare professionals with limited time and resources. In several countries, healthcare professionals can refer patients with mental health issues to structured arts programmes, namely Arts on Prescription (AoP). This study explores the qualitative findings from a 3-year study on Arts on Prescription. Methods: Primary healthcare patients were recruited to participated in a 10-week group-based arts programme, twice a week for 2 h (22 sessions over 10 weeks, comprising a mixture of arts and cultural activities facilitated by arts professionals) referred from 18 different primary healthcare centres. Twenty-eight participants volunteered to be interviewed using a semi-structured one-to-one approach. The transcribed interviews were analysed using a thematic analysis. Results: Three themes were identified as Social community & Connectedness, Self-efficacy and Routine & Structure. Through the identified themes positive effects of psychosocial wellbeing is described as reported by the participants connecting to their experiences of participating in the Arts on Prescription programme including finding common grounds, feeling healthier and more human, connecting with inner resources, and establishing new routines. Conclusions: The findings highlight the potential of Arts on Prescription programmes to promote holistic psychosocial wellbeing, and to facilitate personal growth through community engagement and structured arts activities with salutogenic approaches.

Background: International research demonstrates an association between arts and culture activities and health and wellbeing. A similar association exists for sports event attendance and health. The aim of this study was to investigate associations between arts and culture engagement and attending sports events during the past year and self-rated health (SRH). Methods: A cross-sectional study. A public health survey with three reminders was sent to a stratified random sample of the adult 18–84 population in Scania in the southernmost part of Sweden in October-December 2019. The weighted response rate was 44%, and 40,087 total respondents were included in the present study. Analyses were performed in logistic regression models with multiple adjustments for age, education, country of birth, leisure-time physical activity (LTPA), smoking, alcohol consumption, and economic stress. Results: The prevalence of poor SRH was 32.8% among women and 27.6% among men. The prevalence of theatre/cinema attendance was 63.2% among women and 55.2% among men, arts exhibition/museum attendance was 41.0% among women and 36.0% among men, and for sports attendance it was 33.8% among women and 48.2% among men. All items included in the final models showed statistically significant associations with self-rated health in bivariate logistic regression models. In the multiple model, adjusted for all covariates including both men and women, the odds ratios (ORs) of poor SRH were statistically significant OR 1.21 (95% confidence interval: 1.14–1.29) for not visiting theatre/cinema during the past year, OR 1.11 (1.04–1.17) for not visiting arts exhibition and OR 1.31 (1.24–1.39) for not visiting a sports event. Conclusions: Significant associations between arts and culture engagement and sports event attendance, and SRH were observed, although effect measures were comparatively low for arts and cultural engagement. The results may be useful for informing public health promotion and prevention strategies.

Introduction: The evidence-base for the impact of participating in the arts for different aspects of health and wellbeing is growing. Arts on Prescription has gained increasing recognition as a method for fostering connections among individuals and communities, however, to date no systematic review of the impact on individual health and wellbeing has been conducted. This review aims to provide an understanding of individual health and wellbeing outcomes from participation in Arts on Prescription programmes.Methods: Major electronic databases were systematically searched, including Cochrane Library; Web of Science; ProQuest; CINAHL; Arts & Humanities; Ebsocohost; Pubmed; PsycINFO. Other databases were also used: Google Scholar and websites of specific organizations, e.g., NHS Evidence, Kings Fund, Health foundation, Nuffield Trust and NESTA and University of Florida Arts-in Medicine Repository. The review used PRISMA reporting structures. Critical Appraisal Skills Programme (CASP) templates were used for qualitative and quantitative studies, and the Mixed Methods Appraisal Tool (MMAT) for studies with a mixed methods protocol to assess quality and risk of bias. A narrative review of the qualitative data was conducted. For quantitative outcomes, a meta-analysis for studies that met inclusion criteria was conducted, and a narrative review made of secondary and heterogeneous outcomes and approaches.Results: 7,805 records were identified but only 25 records were included as studies with a focus on the impact on individual health and wellbeing. Studies were conducted in Australia, Denmark, Sweden, United Kingdom, and the United States. Programmes were held in community settings, arts venues, GP surgeries, primary healthcare settings, and one school. Most interventions varied from 8 to 10 weeks and included a wide range of different arts activities. Qualitative themes included social benefits, psychological benefits and progression opportunities. The meta-analysis showed a statistically significant improvement in wellbeing, and the narrative review identified promising outcomes that require further evidential support (e.g., reductions in anxiety and depression).Discussion: Arts on Prescription programmes are an appropriate intervention for improving psychosocial wellbeing, providing both social and psychological benefits as well as progression opportunities. We discuss the various qualitative and quantitative outcomes, along with potential ‘active ingredients’ and barriers to participation (physical, psychological and social).Systematic review registration: PROSPERO, identifier CRD42023408974, https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023408974.

The positive outcomes of engaging in the arts are increasingly reported in the research literature, supporting the use of the arts to enhance individual and community health and wellbeing. However, little attention is given to the less positive aspects of arts engagement. In some countries, healthcare practitioners and link workers can refer service-users experiencing mental health issues to social interventions such as Arts on Prescription (AoP) programmes. This critical review identifies problematic issues across such social prescriptions and AoP, including failures in arts and health projects, participants’ negative experiences, and an absence of ethical guidelines for arts and health practice. Furthermore, it is evident that there is a lack of awareness and knowledge within healthcare systems, leading to inappropriate referrals, failure to take account of individual preferences, and a lack of communication between the third sector and healthcare services. Significantly, it is also unclear who holds the health responsibility for AoP participants. This article raises more questions than it answers, but for AoP to be effectively embedded in healthcare practice, the issues highlighted need to be addressed in order to safeguard participants and support the effective implementation of programmes more widely.