Health Education: 2006; 106, 2; Academic Research Library pg. 155
Community arts for health: an evaluation of a district progranune
Centre for Health Promotion Research, School of Health and Community Care, Leeds Metropolitan University, Leeds, UK
Purpose - The purpose of this paper is to present an evaluation of a community arts for health programme in the UK involving the delivery of three separate projects targeted at disadvantaged Art& Design/methodology/approach - Evaluation plans were drawn up for each project, which linked long-term goals, objectives, indicators of success and data collection methods. Evidence was collected during the projects. In addition, 16 semietnictured interviews were conducted with individuals involved in the programme.
Findings - The projects used a range of creative methods, which were found to be accessible and relevant. A number of short-term health and social outcomes were demonstrated. The programme also had wider impact through strengthening partnership working and the development of knowledge and skills.
Research limitations/implications - Ms was a small-scale study with limited in-depth data from participants. Long-term outcomes were not assessed. There is scope for more studies investigating the impact of arts activity on health and social care organizations and the training needs of staff Practical complications’ - A number of implications for practice emerged from the findings, including the importance of building local ownership and involvement and the development of sustainable activity through partnership working.
Originality/value - This evaluation contnbutes to the small evidence base for arts for health intervention& It identifies outcomes from the activities and discusses issues relating to the development and implementation of community-based arts for health projects.
Keywords: Arts, Health education, Music, Drama. Communities, Partnership, United Kingdom
Paper type Research paper
Over recent years there has been growing interest in the link between arts and health.
It is argued that art, with its focus on creativity, expression and identity, has a unique contribution to make to health and health care (Smith, 2002; Eakin, 2003). Arts for health encompass a number of different types of activity, which vary in purpose, setting and target group. One strand of work that has attracted increasing attention is Social and learning outcomes resulting from the creative activities (see Table 1) may have been transitory.
The qualitative approach allowed issues to be explored in depth and in relation to the project context there were some comparisons between projects that allowed broad themes to be documented, but the evaluation does not provide evidence that can be generalized. There are difficulties in separating the impact of the method (creative arts) from the other influencing factors in each of the projects. Within the qualitative tradition, however, it is important to generate "authentic" accounts (Seale and Silverman, 1997). In this evaluation, evidence was gathered from a range of sources and reflected different practitioner and participant perspectives, as suggested by Kay (2000). Artists were involved in some of the data collection and this could have led to a more positive interpretation of the projects, although the findings from later interviews did not suggest this was the case. One of the weal messes of the evaluation was the lack of in-depth data from participants. Given the potential vulnerability of some participants and the duration of the projects, it was not considered appropriate to undertake extensive evaluation with participants. Overall the study provides a credible account of the processes and short-term outcomes from small-scale arts for health programme.
A means of engagement
The evaluation has provided further evidence to support the use of arts as a method for engaging individuals in disadvantaged communities (Policy Action Team 10, 1999). All the projects were successful at working with potentially marginalized groups and the methods used overcame language and literacy barriers. Ms Show’s arts projects can provide a useful approach to tackling health inequalities, a point reflected in the development of Healthy Living Centre’s (New Opportunities Fund, 2004). There is other evidence to suggest that arts work well in urban communities and are particularly effective at reaching young people (Landry and Matarasso, 1996; Kay, 2000). It was interesting to note that in the community centre project, the acceptability of the creative arts activities was contrasted to the hostility and apathy encountered by other health projects. Reach and access remain important issues if art is to be used to address social exclusion, and in this study not all the projects were able to recruit and retain participants.
The evaluation showed that arts were effective at getting individuals communicating and interacting with each other, both within the groups and with the wider community. The success of the drama project in promoting discussion with young women around health issues is supported by the wealth of evidence about the effectiveness of theatre in education and in community settings (for example, Douglas et al, 2000; Sawney et al, 2003). The community centre project was able to break down barriers and involve young people in a community enterprise within a relatively short time scale. Community cohesion and social networks are significant determinants of health (Acheson, 1998; Wilkinson and Marmot, 1998). These findings support arguments that arts interventions have the potential to be a method for building healthy communities (Health Development Agency, 2000; Green and Tones, 2003). It would require more research to gauge the long-term benefits for communities.
The findings indicated that the projects had a positive impact on practitioners and partner organizations, particularly in terms of development of relationships and networks. It may be that these benefits were simply the result of collaborative working but it is also possible that the creative, expressive dimension to the work in some way assisted in developing and strengthening contacts. Further research would be merited on this. It should be noted that the overall programme was successful at stimulating the development of good partnerships between the arts, health and community sectors. This can be seen as an achievement, given the potential for tensions between those sectors (Tones and Green, 1999; Smith, 2001).
A staged approach
A number of points of good practice emerged from the evaluation of the programme, and these included:
ensuring that projects were relevant to local needs and priorities;
the importance of involving local staff and volunteers before the project is delivered;
detailed information given on the project aims and activities;
spending time to build relationships and develop trust;
Support from the host organization; and
Participants being given an opportunity to plan and develop activities.
These points of learning from the projects are reflected in the principles of community development practice for arts and sports projects in communities (Policy Action Team 10, 1999). A strong theme was the need to develop local ownership of arts projects through involving staff, volunteers and — where possible — participants. Taking time to build relationships emerged as an essential strategy to ensure good levels of recruitment and participation, and ultimately effective activities. As the findings showed, the concept of a staged process was relevant for project delivery and implementation and also as an approach for building health promotion activity. Many interviewees talked of the need to sustain projects. It should be noted that this programme only consisted of a series of short-term projects, while much of the evidence on arts for health has come from initiatives involving multiple strands of activity and/or extended activities over time.
One of the objectives of the programme was to build the capacity of local practitioners to use arts for health and wellbeing. This is one way of ensuring sustainable activities in localities. However, as the findings showed, there was mixed surfaces in doing this. Although it was not the aim of the evaluation to access training needs, it was noted that many of the practitioners were using arts as part of their routine work but had no specialist support, and some indicated that they would appreciate further training. The skills of the artist and the quality of the art work are considered of fundamental importance to developing arts for health (Health Development Agency, 2000) but this study raises the question of whether some training or skills development could usefully be built into projects in order to enhance the capacity of local staff to deliver creative arts in community settings.
Linking to health goals
The short time scales of the projects meant that the evaluation did not measure improvements in health status or changes in health behaviors. There were some health literacy outcomes (Nutbeam, 1998) in terms of increased understanding, awareness and the development of social skills. These findings are reflected in other literature (Matarasso, 1997; Newman et al, 2003). While only short-term outcomes were demonstrated, the projects had the potential to achieve longer-term health gain. The concept of a staged process emerged as significant and many of those interviewed perceived arts could provide a good basis for promoting health in community settings.
Their understandings of the value and contribution of arts is supported by research evidence, for example the Health Development Agency (2000) survey of arts for health projects.
The potential benefit of arts for health is undisputed but this evaluation raised questions about precisely how short-term projects can be linked into the achievement of wider goals. Despite a strategic approach, the connections to the local health agenda were not always fully realized. The programme had resulted in greater awareness about what art could offer, but this was not always matched by shared understandings of what "health" meant in the context of the projects. Some might argue that how things are labeled is not an issue as all art can be seen to be beneficial to health if a broad perspective is taken (Eakin, 2003). On the other hand, such an approach risks arts for health being seen as so general as to be ineffective or alternatively viewed, as one interviewee described, as an "occupied activity", fun while it lasts but with no long-term impact on health and wellbeing.
Given that the majority of organizations wishing to promote health will not have access to unlimited resources to fund long-term arts for health initiatives, the question is how the health benefits from local projects can be maximized. Sustainable activity using arts will require strong partnerships with local health professionals and other practitioners, as well as community-based organizations with the skills, capacity and confidence to carry on the work. The model of developing a health alliance with shared goals and understanding of the contributions of all partners (Douglas, 1998) can be suggested as an appropriate model to develop community arts for heath.
Community arts for health offer new ways of promoting individual and community health. It is an approach with enormous potential for reaching out and working with diverse communities and for tackling health inequalities. The arts for health programme which was the focus of this evaluation was found to be successful in promoting the use of arts for health and supported the development of partnerships between different sectors. Projects were flexible in responding to local needs and accessible to different groups. Creative methods were found to be effective at engaging individuals, including those from disadvantaged communities, and promoting participation in social activities. The results were a range of health and social outcomes, including greater understanding and skills development, not just with the participants but also with partner organizations. Above all, the projects were valued by those taking part.
The challenges in delivering effective community arts initiatives and building partnerships across different sectors should not be underestimated. The evaluation findings suggest that developing local ownership and building trust are essential to maximizing the success of projects. There are also some key issues, such as training and the development of long-term alliances that may need to be addressed if sustainability 'is to be ensured. More research is needed into effective models of delivery within community settings. Arts for health can make a difference, but there is a need for greater understanding of how the arts can contribute to health goals and have a long-term impact on community health.