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A mixed-methods evaluation of the longitudinal impact of arts on prescription

Zalantai, Bethan; Holt, Nicola; Chase, Mike; Jenkinson, Elizabeth

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Bethan Zalantai

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Nicola Holt
Associate Professor in Psychology

Mike Chase
Senior lecturer in Social Psychology


Norma Daykin

Alex Coulter


Art on prescription is one pathway in social prescribing schemes that involves referral by health workers to visual arts programmes, for individuals experiencing social isolation and low to moderate levels of stress, anxiety and depression, with the hope that attendance will improve psychosocial wellbeing. Previous research supports the efficacy of arts on prescription. Pre-post designs have shown that wellbeing scores are significantly higher at the end of programme than at baseline (Crone et al. 2018; Holt, 2020). However, there is a lack of understanding of the longer-term benefits of participation. Only one qualitative study has examined this (Stickley & Eades, 2013), interviewing people two years after participating in an art on prescription programme, and suggested that the social support received had acted as a catalyst for longer-term change. The current study applied a mixed-method framework to further examine the factors influencing participants’ health outcomes following the intervention. Understanding whether improvements to mental wellbeing are maintained on completion of the programmes is important because analyses of qualitative datasets have identified themes relating to ‘fear of relapse’ at the end of programmes (Hughes et al., 2019), which may indicate a subsequent reduction in wellbeing when the support of an arts on prescription group is no longer available. Hence, the present study asked: ‘do participants of arts on prescription courses experience long-term changes to their mental wellbeing?’ A secondary aim of the study was to examine the factors that impact engagement, since participants appear to differentially benefit from the arts on prescription (Holt, 2020; Sumner et al., 2020). Hence, a second research question was ‘what factors influence engagement in arts on prescription programmes?’.

The present study adopted a mixed method, explanatory design (Creswell & Clark, 2007), working with participants who attended arts on prescription workshops, run at three community hubs through Bristol Arts on Referral Alliance in 2018. Participants contacted were those who had agreed to be contacted in the future on their consent form when taking part in an initial pre-post evaluation (Holt, 2020). Twenty participants completed an online survey up to two years after their first workshop, which included the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS) (Tennant et al., 2006). All participants were invited to an interview and nine in-depth, semi-structured interviews took place. Due to the covid-19 pandemic, it was not possible to meet participants face-to-face and consequently participants were offered interviews by telephone (n = 6) or email (n = 3) as an alternative method (Braun & Clarke, 2013). The quantitative data were analysed first, the findings for which helped to develop the interview schedule, in order to further explore and understand the quantitative data. The explanatory design utilised a sequential method of data integration whereby quantitative data, then qualitative data, were analysed separately before being interpreted together. Following transcription, interview data were analysed using Braun and Clarke’s (2006) step-by-step guide to thematic analysis and an inductive analytic approach.

Findings and discussion
Multi-level modelling was used to explore changes in wellbeing over time. Statistically significant differences over time were found for the WEMWBS scores (mean at baseline: 37.69; mean at mid-point = 43.35; mean at end of programme: 42.22; mean at follow-up: 43.45; F(4,80) = 5.83, p =


Zalantai, B., Holt, . . N., Chase, M., & Jenkinson, E. (2021). A mixed-methods evaluation of the longitudinal impact of arts on prescription. In N. Daykin, & A. Coulter (Eds.), Culture, Health and Wellbeing International Conference 2021 CHW21 Research Proceedings (153-155)

Conference Name Culture, Health and Wellbeing International Conference
Start Date Jun 21, 2021
End Date Jun 23, 2021
Acceptance Date Feb 2, 2021
Online Publication Date Jun 8, 2021
Publication Date Jun 8, 2021
Deposit Date Mar 29, 2021
Publicly Available Date Mar 31, 2021
Pages 153-155
Book Title Culture, Health and Wellbeing International Conference 2021 CHW21 Research Proceedings
Keywords Art on prescription, art on referral, longitudinal impact, wellbeing, social prescribing
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