Rebecca Gordon-Nesbitt : Exploring the Long-Term Relationship between Cultural Engagement and Health

May, 2014

There is ample evidence that engagement in cultural activities – across the art forms – has a beneficial effect upon both physical and psychological health. But most of the evidence deals with relatively short-term engagement, over the lifespan of a finite project or a randomised controlled trial, perhaps. This project – based within the strategic agency, Arts for Health, at Manchester Metropolitan University – considers how we might explore this relationship in the longer term.

Perhaps unsurprisingly, the Nordic countries – with both the inclination and resources to explore this connection – are leading the field. In the early 1990s, a Swedish team revisited a cohort of 12,982 people who had taken part in a survey in 1982–3 which included questions about cultural engagement. They found that 533 men and 314 women had died during the intervening years and that, after adjusting for a range of demographic and lifestyle factors, cultural engagement seemed to increase survival chances. This landmark study, which was published in the British Medical Journal and repeated five years later with the same results, tentatively indicated possible areas of future research and was taken up by research teams throughout the Nordic region. Teams in Finland have substantiated the link between cultural participation and survival in large population samples, specifically in relation to external causes of mortality such as accidents and suicide. In the Norwegian county of Nord-Trøndelag, where biological samples and lifestyle data have been collected since the mid-1980s, questions about cultural engagement were introduced into the latest round of surveys (2006–8). This population-wide databank holds the potential for elucidating longitudinal connections between cultural engagement, self-reported health and the body’s physical and chemical properties.

Participation in the Cultural Value Project has enabled meetings with many of the esteemed researchers in this area of research, facilitating consultations in the Nordic countries about the work that has been done to date and the methodological challenges that remain in the future. At the same time, discussions have been undertaken with those at the forefront of similar research in the UK, from statisticians at the Department of Culture, Media and Sport, responsible for interpretations of the Taking Part survey of arts participation, to representatives of arts and health organisations who actualise the relationship between arts participation and health on a daily basis.

Viewed from its midpoint, this project raises as many questions as it answers, not least in relation to why cultural engagement might have a beneficial impact upon health and life expectancy. Various explanations have been offered, ranging from alterations in brain morphology to better functioning of biological regulatory systems to increased social capital to epigenetic phenomena. The next three months will be spent trying to unravel this connection while paying close attention to the distinction between passive attendance at cultural events and active participation in arts activities.

You find out more about our project on the blog.

Dr Shona Kelly: A Critical Review of the Effectiveness of the Therapeutic Use of Artistic Activity

Connections between art and therapy have existed for centuries. The Victorian poet Matthew Arnold often wrote on the functions that poetry could perform in society, once remarking that ‘mankind will discover that we have to turn to poetry to interpret life for us, to console us, to sustain us’. Along with philosophers, artists, and other writers through the ages, Arnold saw the extrinsic value of the arts to wider culture and society.

Arnold’s ideas on the consoling and sustaining functions of art are prescient of more recent uses of art as therapy in healthcare settings. Professional therapy has come to see the value of artistic activity for patients, and although we cannot know for sure if Arnold would advocate choirs being set up in care homes or poetry-writing classes in community centres, there are plenty of researchers and practitioners today who support such interventions, arguing that these have multiple therapeutic benefits to patients and participants. Quality research into the value of arts therapy is now catching-up with the anecdotal evidence and, as such, it is a very exciting time to be conducting a review of this research.

Researchers from a variety of fields have attempted to measure the effects of arts interventions on clinical outcomes for patients. Although in many cases this research is valuable and the findings valid, there tends to be a lack of cohesion across these studies and a lack of policy purpose driving the individual pieces of research. Against this background, our aim in this review is to assess the effectiveness of arts therapy for the patient, with the view of making positive recommendations to policy makers and service providers. In practice, conducting this critical review involved setting out the criteria for literature to be included in the review, double-reading all the papers that meet the criteria, and classifying these. Putting it like that makes it sound simple… unfortunately this isn’t the case!

There are six of us on the project team. All of us work at Sheffield Hallam University, but each of us came to the review with very different expertise. Although some members of the team have experience of conducting critical reviews and other members have extensive knowledge of arts therapy literature, there were many challenges. The first challenge of the review was to find the best search terms to use when scouring the databases, so that the papers we read did justice to the breadth of arts therapy research, while at the same time leaving us with an extensive yet manageable number of papers to sift through. Even when the most appropriate search terms had been found, searching the databases for relevant literature threw up thousands of results. At this stage, technology can help you no more and the results had to be manually checked for relevance. Compared to other disciplines within healthcare, there is a lack of specialist vocabulary in arts therapy research and many of the terms are in common, everyday usage (e.g. writing, sing, dance); in addition, some of these key terms are used in rather different ways in other disciplines (a search for film gives us results of papers about polymer films…). For these reasons, a good proportion of the results returned by the database searches are irrelevant, so the abstracts we end up looking through are on a variety of subjects: the benefits of bibliotherapy, and the nesting habits of the Nelson’s Sparrow.

As is the nature of this kind of review, some very valuable and relevant research into arts therapy has to be cut out of the process. As you might expect, much of the research in arts therapy is qualitative, and a lot of the studies are reports from personal experience: e.g. health practitioners reflecting on the value of ballroom dancing classes in a nursing home. Although qualitative research and personal reports have provided excellent background reading for our review, we are focused on reviewing studies that seek to quantify measures of patient improvement following engagement with the arts. Quantitative study design is the only way to discern cause and effect, which is vital if we are going to produce a compelling case about the benefits of arts therapy.

At this stage we have produced a preliminary review and continue to further analyse and summarise the research we identified.  We have been pleasantly surprised at the increasing amount of quantitative research over the past decade.  However, the nature of the patients served by art therapy (i.e. the use of arts in therapeutic interventions) is particularly challenging to engage in research.  The patients who tend to be offered arts based interventions often have complex conditions, and may not have responded to other treatments. For example, people with severe mental illnesses, living in challenging environments, experiencing fluctuating conditions are often found in small cohorts under different organisations, and tend to drop out of studies much more than convenient samples of university students. Another factor is the nature of arts therapy media themselves, which are rarely standardised intervention: practitioners vary in approach and techniques, and many of the environmental condiitons in which the therapy is practised are specific to local situations. In most cases participants select whether they want to particpate in arts therapies which is uncommon practice in more clinically-focused medical therapies. In others, some people may not really have the interest in the medium but go along with the treatment being offered.  These factors complicate issues around participation. Arts therapies cannot be reduced to the administering of a standardised surgical procedure or pharmaceutical prescription. However, just because such a variety of different situations is part of the engagements patients may have, does not mean that because comparison is difficult no benefit can be percieved. A constructive critique is being prepared.