Community arts for health: an evaluation of a district progranune

Health Education: 2006; 106, 2; Academic Research Library pg. 155
Community arts for health: an evaluation of a district progranune
Jane South
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.


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