Arts for Health's Sake

Overview

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) hosted a one-day virtual workshop titled "Arts for Health’s Sake” on Tuesday, June 11th, 2024. The intersection of arts and health has gained significant attention due to the potential to enhance well-being and address various health challenges. This workshop was organized to learn how the arts are being used to dissemination health knowledge and in implementation science as both evidence-based interventions and strategies.

Key Questions and Gaps

• What arts-based interventions for health are ready for implementation?
• What are the best examples of using arts to disseminate health knowledge?
• What are the most promising art-based implementation strategies?

Videocast Link

https://videocast.nih.gov/watch=54855

Background

The arts encompass a wide range of activities, each offering unique contributions to health and well-being. Performing arts such as music, dance, theater, and film provide immersive experiences that enhance emotional expression and social connection. Visual arts and crafts, including textiles, painting, photography, and sculpture, offer avenues for creativity and self-expression which can have therapeutic benefits. Digital and electronic arts such as animations, digital photography, and electronic art bring innovative ways to engage with art and offer new platforms for therapeutic interventions. Literature promotes cognitive engagement and emotional processing through activities such as writing, reading, and attending literary festivals. Cultural activities including visits to museums, galleries, art exhibitions, concerts, and community events foster a sense of belonging and community engagement. Heritage activities such as visiting stately homes, parks, monuments, and historical sites connect individuals with their cultural roots and promote mental well-being. Design and environmental arts, encompassing architecture, interior design, light, and sound, create spaces that can influence mood, stress levels, and overall health.

Despite the growing body of evidence supporting the benefits of arts engagement, several challenges remain in integrating the arts into health systems and communities that could benefit. These challenges include understanding the specific mechanisms through which arts impact health, ensuring equitable access to arts interventions, and overcoming practical barriers to implementation. This workshop aimed to address these challenges by bringing together diverse perspectives and expertise to share insights, discuss barriers, and identify opportunities for advancing the field. The workshop was designed to address three goals. One, sharing art-based interventions for health that are ready for implementation. Two, surfacing examples of using arts to disseminate health knowledge. Three, exploring the most promising art-based strategies for implementing heart, lung, blood, and sleep evidence-based interventions.

Summary

The Impact of Arts on Health

This workshop reviewed extensive research highlighting the significant impact of arts and cultural participation on health at a population level. Numerous research papers have documented the positive effects of arts on mental health, acute conditions, and noncommunicable diseases, including cardiovascular and respiratory outcomes [1]. The evidence supporting the role of arts in health was both clear and compelling, showing that arts engagement consistently enhances general well-being and improves various health outcomes. Arts engagement has shown significant enhancement of mental health across various forms, with music playing a vital role in language acquisition and contributing to cognitive reserve in conditions such as dementia, Alzheimer’s, and Parkinson’s. Additionally, arts engagement has contributed to improved maternal and infant health during prenatal and postnatal periods, reduced stress, improved cardiovascular health, enhanced immune function and sleep quality, better physical activity, and some benefits in substance abuse recovery [1]. These examples represent a fraction of the extensive evidence supporting the significant role of arts in enhancing myriad health outcomes.

Arts in Health Dissemination

The arts can serve as a vehicle for influencing health-related behaviors and decision-making. This workshop examined the use of arts to disseminate health knowledge highlighting the impact of community-driven approaches. Effective mediums for community engagement included short films, photography, storytelling, and music. Innovative initiatives such as the Native American Research Internship Film “Winding Path,” AfroBeats for stroke awareness in Nigeria [2], the Trico Changemakers Studio’s Facilitator Card Deck, and the edutainment mobile game Go Nisha Go for menstrual health education in India [3] showcased diverse applications of arts in health education and communication globally. These examples underscore the vast potential for arts to play a pivotal role in promoting health equity and education, and emphasized the importance of artist support and collaboration with policymakers for successful health information dissemination.

Strategies for Implementing Arts-Based Interventions

The workshop highlighted the INgredients iN ArTs in hEalth (INNATE) framework [4], which identifies essential components of arts activities—dose, format, social composition, leadership, and context—that contribute to health benefits. Further exploration of these mechanisms is necessary to advance art-based initiatives, and standardizing these active ingredients can enhance replicability and effectiveness across various contexts. Hybrid research designs, which assess both effectiveness and implementation simultaneously, were recommended to test scaling arts-based interventions while comprehensively understanding their impact. Effective implementation also requires an understanding of the medical context, specific art materials, and intended beneficiaries while addressing systemic challenges and ensuring access and equity. A holistic approach to implementing arts-based health interventions necessitates a comprehensive knowledge of both the arts and the target communities, thus, collaborations with communities, policymakers, and stakeholders from the outset are crucial to align efforts and establish supportive frameworks and policies. Utilizing art therapists to gather and leverage information within existing infrastructures was also noted as a beneficial strategy. Implementation efforts should focus on developing self-sustaining models, particularly in collaboration with clinical partners. Additionally, engaging in co-creation with community members, artists, and collaborators throughout the design, implementation, and dissemination phases will help promote intervention sustainability.

A Ready-to-Scale Example

Social prescribing emerged as a promising example of integrating arts into health and prevention strategies.  This scale-up ready intervention has garnered significant interest from healthcare professionals, highlighting its potential to provide new solutions through arts-based methods. A crucial component of social prescribing is the role of link workers who connect patients to relevant organizations and networks based on their backgrounds. The discussion focused on further developing and clearly defining the role of link workers, as well as addressing workforce development and management to effectively meet patients' needs.

Barriers to Implementation

The discussions and presentations highlighted the gaps and opportunities in the field of arts and health. Barriers to implementing arts-based health interventions include the necessity for comprehensive training and dedicated academic programs. Clinical services must be equipped to integrate these interventions, requiring appropriately trained professionals to meet patient needs effectively. A dedicated team is essential to liaise with clinical services as healthcare professionals often lack the capacity to manage these additional roles. Despite significant progress, there remains a considerable opportunity to develop curricula in the public health domain that focus on effectively working with the arts and artists. Establishing collaborative spaces and addressing complications that arise from racial and gender dynamics are also critical. Overcoming communication barriers between arts and science participants while balancing scientific rigor with artistic freedom is essential. For long-term success, it is crucial to conduct formative research on target populations to tailor interventions effectively and understand the sustainability of roles and responsibilities. There is a clear need for evidence-based frameworks to guide the implementation of arts interventions, ensuring their sustainability and integration into broader health strategies. Integrating communities and artists into decision-making and training processes promotes sustainability. Additionally, a clear understanding of how the arts are supported, and an art taxonomy are needed, as different arts are communicated and engaged with differently. Consideration of the utilization factor from the outset and exploring private-sector strategies, such as advertisements and marketing, can also support sustainability. This exploration sets the stage for future research and the development of effective, scalable, and sustainable arts-based health interventions.

Conclusion

The workshop successfully highlighted the potential of arts dissemination of health information and implementation science. Participants emphasized the importance of creative collaborations, supporting artists, and ensuring sustainability. The insights and discussions from this workshop will inform future research efforts to study integration of arts into health policies and practices.

Key Opportunities and Gaps

• Further explore and elucidate the mechanisms through which arts impact health outcomes, enhancing the scientific basis for these interventions and addressing disparities in access.
• Develop standardized frameworks to identify key components of effective arts activities and use research designs that assess both effectiveness and implementation.
• Use diverse art forms, such as short films, photography, storytelling, and music, to disseminate health knowledge, promote health equity, and explore private-sector strategies for financial sustainability.
• Engage community members, artists, and collaborators throughout the research design, implementation, and dissemination phases to ensure interventions are relevant and sustainable.
• Prepare clinical services to incorporate arts-based interventions by ensuring healthcare providers are adequately trained and supported, leveraging the existing infrastructures.
• Use social prescribing as a model to bridge the gap between healthcare and community resources.
• Develop dedicated academic programs that focus on the integration of arts and health, providing comprehensive training for healthcare providers and artists, and overcoming communication barriers between arts and science participants.
• Conduct multisite studies to provide robust, generalizable evidence for the efficacy of arts-based health interventions, addressing legal and ethical issues, and maintaining long-term support.

Disclaimer: The findings, knowledge gaps, and opportunities described here represent a summary of individual opinions and ideas expressed during the workshop. The summary does not represent a consensus opinion or directive made to or by NHLBI or NIH.

Participants

Presenters

• Daisy Fancourt, PhD, Professor, University College London
• Juliet Iwelumor, PhD, Professor, Washington University School of Medicine
• Maria Rosario Jackson, PhD, Chair, National Endowment for the Arts

Workshop Organizers

• Paul Burns, PhD, Program Director, National Institute on Minority Health and Health Disparities
• Maliha Ilias, PhD, Senior Program Director, Center for Translation Research and Implementation Science, , NHLBI
• Keith Mintzer, PhD, Program Director, Center for Translation Research and Implementation Science, , NHLBI
• Ajay Yadava, Program Analyst, Center for Translation Research and Implementation Science, NHLBI

Workshop Leadership

• Cara C. Lewis, PhD, Deputy Director, Center for Translation Research and Implementation Science, NHLBI

References

1. Fancourt, D., et al., What is the evidence on the role of the arts in improving health and well-being? : a scoping review, in Health evidence network synthesis report, 67. 2019, WHO Regional Office for Europe,: Copenhagen. p. 1 online resource (1 PDF file (ix, 133 pages)).

2. Nwaozuru, U., et al., Addressing Stroke Literacy in Nigeria Through Music: A Qualitative Study of Community Perspectives. Journal of Stroke & Cerebrovascular Diseases, 2020. 29(12).

3. Shankar, L., A. Dixit, and S. Howard, A Design-Led Theory of Change for a Mobile Game App (Go Nisha Go) for Adolescent Girls in India: Multimix Methodology Study. Jmir Formative Research, 2023. 7.

4. Warran, K., A. Burton, and D. Fancourt, What are the active ingredients of 'arts in health' activities? Development of the INgredients iN ArTs in hEalth (INNATE) Framework. Wellcome Open Res, 2022. 7: p. 10.