Engaging the Arts for Wellbeing in the United States of America: A Scoping Review

Engaging the Arts for Wellbeing in the United States of America: A Scoping Review

There is increasing interest today in how the arts contribute to individual and community wellbeing. This scoping review identified and examined ways in which the arts have been used to address wellbeing in communities in the United States. The review examined forty-four publications, with combined study populations representing a total of five thousand eighty research participants, including marginalized populations. It identified the types of artistic practices and interventions being conducted, research methods, and outcomes measured. It highlights positive associations found across a broad spectrum of psychological, physical, and social outcomes, including improvements in self-esteem and identity formation, cognition, physical balance, and physical conditioning. It also reports negative outcomes of arts interventions that may be underreported. The study identifies the need for core outcomes sets and reporting guidelines for advancing evidence synthesis in this area.

INTRODUCTION

There is increasing interest across the health sciences in how the arts contribute to health and wellbeing, as evidenced by initiatives such as the World Health Organization's Global Arts and Health Program and an upsurge in evidence synthesis, including scoping and systematic reviews. This article reports the results of a scoping review on how the arts have been used in the recent past to address wellbeing in communities in the United States.

Wellbeing and the arts are both difficult to define, and neither concept has a single universally accepted definition. This lack of definition results naturally from the breadth and complexity of each domain, yet presents significant challenges to research-both within and at the intersections of the domains.

The challenge of defining wellbeing and identifying its implications for research have been frequently noted and numerous definitions or frames for wellbeing have been offered. Dodge et al. reviewed attempts to define the concept in scholarly literature and proposed a definition of wellbeing as "the balance point between an individual's resource pool and the challenges faced." This definition centers on the fluctuating balance of challenges and resources across psychological, physical, and social dimensions. Other definitions focus on how individuals evaluate their own lives. For example, the Robert Wood Johnson Foundation describes wellbeing as "the comprehensive view of how individuals and communities experience and evaluate their lives, including their physical and mental health and having the skills and opportunities to construct meaningful futures." Similarly, relational wellbeing represents an interchange between personal, social, and environmental processes that is socially and culturally created and occurring in a particular time and place. In the recent World Health Organization report on the arts, health and wellbeing, the concept is framed subjectively to include "affective wellbeing (positive emotions in our daily lives), evaluative wellbeing (our life satisfaction) and eudemonic wellbeing (our sense of meaning, control, autonomy, and purpose in our lives)."

Similarly, and understandably, "the arts" also defy common definition. The arts have many forms and interpretations; and represent experiences that are also subjectively defined. Fancourt and Finn, however, offer several fundamental and cross-cultural characteristics of the arts, including presence of an object or experience that is valued beyond its utility, imaginative experiences, and emotional involvement. Davies et al. offer a working definition in the form of a classification of art forms specifically for research on the arts in relation to health, including: performing arts; visual arts, design, and craft; community/cultural festivals, fairs and events; literature; and online, digital and electronic arts. These categories were created specifically for studies of arts in health, and those that seek to explore causal pathways that link the arts to health outcomes. This definition recognizes a range of engagement with the arts, from participatory art making to listening, viewing, or watching. Recognizing that passive is a flawed term in this context-as listening and watching are not fully passive, but invite active cognitive, emotional, and other forms of engagement and participation- the terms active participation and receptive participation are used to represent this distinction.

Interest in the arts as a means for promoting health and enhancing wellbeing has expanded significantly in recent decades. A recent World Health Organization report presented a scoping review of over three thousand publications that investigate the arts in relation to health and wellbeing. In the United Kingdom and several other countries, arts activities are prescribed within national or regional social prescribing, or "arts on prescription," programs. Outcomes of these programs include improved wellbeing, physical and mental health, social support, and management of health-related conditions, as well as health care cost reduction and decrease in emergency room use.

Redmond et al. While several state or regional pilots are currently under way, no national social prescribing structures have been developed in the United States.

There is also a growing body of research exploring how the arts contribute to wellbeing at the community level. Recent studies and reports suggest that arts and cultural practices enhance social cohesion, preserve culturally relevant social capital, and contribute to healthy communities, as well as to individual wellbeing. The two thousand seventeen Survey of Arts Participation in the United States, a nationally representative survey, reported that fifty-four percent of US adults attend creative, arts or cultural activities, fifty-four percent create or perform art, fifty-seven percent read short stories, novels, poems or plays, and seventy-four percent use electronic media to consume artistic content. Analyses of data from the General Social Survey also confirmed a social gradient in arts participation in the United States, with greater disparity in attendance at arts events than in participation in arts activities. In a recent statistical study, Bone et al. found positive associations between participation in arts groups and elements of evaluative, experienced, and eudaimonic wellbeing in the United States population.

The field of arts in health in the United States has focused strongly on the use of the arts in clinical settings. Many studies and reviews globally include reports on arts interventions that take place in the clinical setting such as Deatrich et al., Cosio and Lin, Fancourt and Finn, Golden et al., and Ambler et al. However, work is also being done throughout the country that engages the arts to address wellbeing outside of clinical settings, at the population and community level. For this reason, this review was designed to include only studies that occurred in the community with a focus on wellbeing and in a public health context. From a public health perspective, wellbeing contributes to disease prevention and health promotion by integrating physical and mental health. Understanding of how wellbeing contributes to disease prevention and health promotion builds upon the World Health Organization's definition of health as a "state of complete physical, mental and social wellbeing and not merely the absence of disease and infirmity."

The overall aim of this scoping review was to identify and examine ways in which the arts have been used to address wellbeing in communities in the United States. The objectives were to identify the types of artistic practices, tools used, and interventions being conducted to address wellbeing in communities.

This review describes study populations, research designs, art forms, wellbeing frameworks, interventions, and outcomes. Studies were included that either describe their purpose as addressing wellbeing or were determined by the researchers to address one or more of the key components of wellbeing: psychological, physical, or social. The review also identifies gaps in literature and offers recommendations for future work in the field.