Overview
Ageing is a growing concern in many countries. In the UK, the number of older adults (age 65+) is set to rise to almost 25% of the population over the next 20 years (Age UK, 2013; ONS, 2015). Although people are living longer, they are not necessarily living well. Getting older has been associated with social isolation (i.e., loss of partner, friends, family members; exclusion from society), which can have a negative impact on health and well-being (e.g., feelings of loneliness, poor quality of life, development of illness; Cacioppo & Patrick, 2008; Perissinotto et al., 2012). Given these shifting demographics, novel, cost-effective solutions that help older adults to stay connected and age well are paramount. This PhD project will consider one such solution, participatory arts interventions(e.g., music, drawing, theatre, writing).Drawing from the social identity approach to health and well-being and knowledge about arts practice,this project will investigatehow and why involvement in participatory arts interventions in general, and Entelechy Arts’ Meet Me at The Albany (MMA) programs in particular, reduce isolation and improvehealth and well-being over time.
Theoretical and Empirical Support for Group Interventions: The Social Cure
Drawing on social identity theory, a new theoretical innovation has recently been proposed - the social identity approach to health and well-being (Jetten et al., 2014). This approach states that the identification and belonging offered by groups can contribute to health and well-being, in effect comprising a social cure. Jones and her colleagues’ research using this approach is amassing evidence of the benefits of group interventions for older adults. For instance, the provision of a gender-based club for older men living in residential care was associated with higher residential community engagement and lower depression (Gentleman’s clubs; Gleibs et al., 2011a), and an intervention to increase water intake was associated with increased feelings of social support and fewer calls to GPs among care home residents when delivered in groups rather than individually (Water clubs; Gleibs et al., 2011b). These findings suggest thatshared experiences with peers can promote connectedness, and thereby health and well-being, through support and engagement. This PhD project merges these ideas with artistic practice to explain how (i.e., connectedness) and why (i.e., support and engagement) participatory arts interventions promote benefits.
Participatory Arts: Cognitive, emotional and social pathways to support and engagement
Participatory arts interventions can be understood as a spectrum of artistic practice moving through active engagement, where participants contribute to work through stories, ideas or performances, collaborative making, where the artist(s) remain in the leading creative role but participants have a direct involvement in the creation of the final piece, co-creation, where power is delegated to the participants as they take growing control of the artistic creation through the creative process and participants’ initiative, where participants instigate and realise their own creative idea (McFadden & Basting, 2015; Tiller, 2014). Although we know that participatory arts interventions are associated with health and well-being benefits for older adults, this research is often missing a theoretical framework, consideration of underlying mechanism(s), studies with pre-post designs and controls groups, and assessment of long-term effects (Cann, 2016; Noice et al., 2013).Thinking about these issues from a social psychological perspective, existing theory and methodology can be used to address these issues.Drawing from the social identity approach to health and well-being, we propose that participatory arts interventions can reduce isolation and benefit health and well-being through the sense of connectedness fostered through these intervention groups. These groups then enable individuals to access support and engagement throughone, or a combination, of pathways: Taking part in activities with peerspresents an opportunity to change perception and beliefs about one’s self, the world, and one’s involvement within it (cognitive pathway);Change the way people connect, identify, and interact with others (social pathway); and enable people to feel good about themselves, their experiences, and their capabilities (emotional pathway). These pathways reflect theoretically grounded, novel, and testablemechanisms through which participatory art interventionspromote benefits. This work is a critical step in quantifying the processes that linkarts practice with health and well-being outcomes for older adults. In addition to reviewing the literature and examining secondary datasets to test these ideas, this project will investigate these relationships in cross-sectional and longitudinal studies in a real-world participatory arts intervention.
Community-based Participatory Arts Intervention: Entelechy Arts and MMA
A recognized National Portfolio Organisation of the Arts Council of England, Entelechy Arts has developed MMA, a creative arts club for the over 60s, in collaboration with regional arts space The Albany and the London Borough of Lewisham, to address the social needs and creative aspirations of isolated older people within the community. The programcomprises three main activities that enable older adults to engage with the arts in different ways: Birds and the Egyptians: visual and tactile arts; Flying/ Falling: Movement, physical activity and balance; and Couplets & Cuppas: creative writing and poetry. Uniquely, older adults can take part in one or more of these activities and the activities support a range of functional issues (e.g., difficulty with vision or mobility). In recognition of this pioneering program, Entelechy Arts gave evidence to the All-Party Parliamentary Group on Arts, Health and Well-being (July 2015) and was included as one of the 12 health case studies of best practice in the Department for Culture, Media and Sport’s Culture White Paper (UK Parliament, March 2016). A necessary next step is to quantify the benefits of the MMA program especially with respect to isolation, and health and well-being. Working with this partner, we can test if our theoretically informed effects and processes are observed across different arts practices and over time.
Proposed Project: Aim and Research Questions
Aim: Investigate how and why participatory arts interventions benefit older adults’ health and well-being.The project will address threeresearch questions:1.How are the impacts of participatory arts interventions on older adults’ isolation, health and well-being described in the literature?2.What are the relationships between arts involvement, connectedness, support,engagement, and health and well-being for older adults?3. Does MMA promote connection,and thereby, health and wellbeing? Is this explained through different pathways to support and engagement?
Proposed Design, Methodology, and Timescales
To address Research Question 1, the PhD student will conduct a review of the published and grey literature on participatory artsinterventions and isolation, health and wellbeing for older adults (see Chandler et al., 2013; Higgins & Green, 2011;Months 1-6).To address Research Question 2, the PhD student willfocus on older adults (65+) from the Understanding Society survey, with completed measures of arts involvement, identification, social connection quality and quantity, social support, community and cultural engagement, and mental and physical health and well-being over several time points. The student will learn and use advanced statistical techniques (e.g., Linear Multilevel Modeling (LMM; West et al., 2014)) to examine relationships and change over time; Months 7-12).To address Research Question 3, the PhD student will conduct two studies. Study 1 is a quantitative, cross-sectional survey of older adults taking part in MMA’s programs (N=30; all current attendees; maximum capacity of program) and those awaiting entry into these programs (Waitlist control (n=30); Months 13-18). After completing informed consent, participants will indicate the activity (or activities) they are currently taking part in and evaluate the associated cognitive, social, and emotional elements (e.g., perspective on ageing, the arts, curiosity, risk-taking, perceived connection to others). Participants will provide ratings of number of friends, sociality, isolation, loneliness, community identification, community support, community engagement, happiness, life satisfaction, anxiety, depression, affect, subjective vitality, agency and control. Data Analyses. Pearson’s correlations will be used to examine the associations between the variables measured and recorded. Multiple regression will test whether specific MMA program(s), connectedness, and/or cognitive, social, and/or emotional pathways predict health and well-being outcomes (TabachnickFidell, 2012). PROCESS (Hayes, 2012) will test mediation models to examine if MMA influences connectedness and health and well-being through various support and engagement pathways. InStudy 2a mixed methods, longitudinal approach will be adopted with 30 new participantsto MMA’s programs(Months 19-30).Qualitative interviews will ask participants to describe their subjective experiences of taking part in one of the arts activities at 3 and 9 months after first participation. Interviews will be complemented by longitudinalpre- post- surveys. Participants will complete the measures outlined in Study 1 as well as measures of perceived support and engagement before taking part for the first time (baseline). At 6 and12 months, participants will complete additional surveys where they will indicate their current arts activity, complete evaluations of its cognitive, social, and emotional elements, as well as completing the same measures as at baseline. Data Analyses.Interviews will be subjected to thematic analysis (Braun & Clark, 2006, 2014). For the quantitative data, in addition to the analyses outlined above, LMM will assess whether changes to connectedness, support and engagement and/or its associated pathways, predict changes in health and well-beingfor older adults over time.
Project Fit, Dissemination, Knowledge Exchange, and Impact
This project aligns well with the Life Course, Psychology & Health thematic pathway. Inusing social psychology to advance knowledge aboutparticipatory arts interventions, it meets a real needin health and social care for programs that help older adults to age well. In linking processes to outcomes, this project can provide important guidelines for designing, implementing and evaluating similar interventions locally, nationally, and globally (i.e., impacts, cost-effectiveness). QMUL and Entelechy Arts collaborated on the design of the project ensuring thatknowledge gained will be relevant for both academics and external partners.Findings will be shared with older adults and with other key stakeholders (e.g., Local Councils, Public Health Services, Policy Makers, Clinical Commissioning Groups) via cross-sector round-table events co-organised with Entelechy Arts, andacademic conferences (e.g., World Congress on Gerontology and Geriatrics). Findings will be prepared for high impact interdisciplinary journals (e.g., PNAS, Psychology and Aging) and, for Entelechy Arts, findingswill be used todemonstrate the effectiveness of MMA and refine their service delivery. This will support the organisation’s future bids for capital and program funding.
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