'You come as a human being ': exploring sense of equality in arts interventions through an ethnographic study of Shared Reading.

Research shows that the arts hold a particular potential for promoting health, well-being and social inclusion for vulnerable people. However, the use and consumption of the arts tend to be socially skewed in favour of people with high cultural, social and economic capital. While extensive research has been conducted on how to create equal access to arts activities for vulnerable groups, little research has investigated how to ensure meaningful engagement with the arts by this group. Shared Reading (SR) has had considerable success in engaging vulnerable groups in collective literary practices, and research suggests that this may partly be due to the unique forms of social and literary engagement that the concept fosters. These forms of engagement, we suggest, lay the foundation for a sense of equality among participants that may promote social connectedness and well-being. On this basis, the present study aims to investigate whether and how a sense of equality may play a role in SR practices. The study found that SR promotes a sense of equality by creating a space where social interaction and relatedness does not hinge on social roles, but rather on lived experiences-and vulnerabilities inherent to these-conveyed through literary texts and shared among participants. However, to promote a sense of equality in SR, meaningful engagement for all participants must be ensured, making facilitation an essential element of SR practices and an important focus in arts interventions in general. We conclude that SR, and arts interventions more generally, may be a promising way to promote a sense of equality, but further research is needed on the specific qualities of and potential contexts for the promotion of a sense of equality.

'The book's a conversation starter': a realist exploration of the salutogenic potential of reading for pleasure.

Reading for Wellbeing (RfW) is a pilot initiative, aimed at improving mental health and well-being through supporting access and increasing opportunities to read for pleasure. RfW was implemented across six North-East local authorities in England and employed Community Reading Workers to support access to books and reading for targeted populations. The current study used realist methodology to understand context, potential mechanisms of action, acceptability and reported outcomes. Data generation and analysis were conducted iteratively, using focus groups, interviews and observations.The analysis of the collated data highlighted that a positive attitude towards reading and a desire for social connections were significant motivators for engagement with RfW. This paper postulates eight programme theories relating to that context, which describe key mechanisms within RfW linked to engagement with reading, well-being, connections and practice. The paper concludes that previous notions of positivity associated with reading for pleasure enable participants to experience RfW as a positive social encounter. This positive social encounter enhances participants' multiple resistance resources such as increased sense of self-efficacy and connectedness that could impact on their sense of well-being.

Bridging comic art and research: lessons from an interdisciplinary collaboration project in a palliative care context.

The Dutch graphic novel Naasten, about palliative family caregiving, is the product of an interdisciplinary collaboration between researchers and two comic artists. This paper aims to present lessons, reflections and practical recommendations for other researchers interested in adopting (comic) arts-based research methods, in which artistic methods are used as novel ways for generating, analysing, interpreting or representing research data.Our project started with the goal of translation: we aimed at representing research findings into a more accessible, visual and textual form to stimulate discussion and reflection outside academia on moral challenges in family care. This was inspired by comics' hypothesised potential to show complex and embodied experiences, thus enabling more understanding in readers and offering powerful science communication tools. Although this goal of translation was realised in our project, we learnt along the way that the project could have benefited from a more explicit focus on interdisciplinarity from the start and by monitoring the interdisciplinary learning opportunities throughout the project. The following issues are important for any art-research collaboration: (1) an interest in and acknowledgement of each other's (potentially diverging) aims and roles: all parties should-from the start-commit themselves to interdisciplinary collaboration and to exploring the added value of using each other's methods, thereby finding a common methodological ground and language; (2) a continuous discussion of the sometimes contrasting approaches between artists and researchers: differences in using theory and story may result in different criteria for creating good art. When balancing scientific and aesthetic aims, the trustworthiness of the art work should remain an important criterion; (3) an awareness of the potential of interdisciplinary collaboration to offering new perspectives on one's scientific data collection and analysis, for example, providing other conceptualisations or indicating blind spots, provided that artists are involved in the early phases of research.

Adolescent idiopathic scoliosis: interdisciplinary creative art practice and nature connections.

Scoliosis is an abnormal lateral curvature of the spine with the large majority of cases classed as idiopathic, meaning there is no known cause. Typically, most cases occur in children and young people affecting approximately three per cent of the adult populace with five out of six cases being female. The BackBone: Interdisciplinary Creative Practices and Body Positive Resilience pilot research study used arts and humanities methods to measure the impact of adolescent idiopathic scoliosis (AIS) on well-being and body perception. The research aimed to contribute to a better understanding of alternative treatments towards improving quality of life in young women diagnosed with AIS. In particular, concentrating on two highlighted priorities from the Scoliosis Priority Setting Partnership: (1) How is quality of life affected by scoliosis and its treatment? How can we measure this in ways that are meaningful to patients? (2) How are the psychological impacts (including on body image) of diagnosis and treatment best managed.Using established medical techniques, art-based workshops, and focus groups with postoperative participants with AIS and their families we gathered both quantitative and qualitative data. The workshops explored the aesthetics of imperfection through material investigations that focus on the body as both an object and how it is experienced using the metaphor of tree images. Drawing parallels between the growth patterns of trees that, for complex and often unknown reasons, have grown unexpectedly we explored questions around ideological notions of perfect growth through art-making in a non-clinical setting. Uniquely, the pilot project sought to draw on insights from four key disciplines (art, medicine, psychology and human geography), thinking across boundaries to evoke different ways of knowing and understanding the complexities of body perception through image-making.

Can 'life writing' be therapeutic in response to trauma? An exploratory research project in Medical Humanities in South Africa.

The therapeutic benefit of expressive writing has been well researched in the Global North but there is no literature from the Global South. Potentially healing interventions need to be investigated in different contexts, particularly where there is a need to build social cohesion. South Africa has a violent past and is a highly stressed society. An exploration of self-reports by a diverse group of South Africans on the effects of life writing on their health and well-being was conducted using qualitative methods. Twenty members of a writing collective, the Life Righting Collective (LRC: www.liferighting.co.za), were purposively sampled and interviewed by medical students as part of a Medical Humanities special study module. Five major interconnected themes emerged. The LRC as a specific intervention was central to the benefits described. The findings of this study indicated that life writing is a useful non-medical, cost-efficient method to improve resilience to trauma, as well as improving the psychological well-being of the participants. In addition, participants reported positive experiences regarding personal development, overall wellness and mental health, and that life writing can engender a sense of community. Resource-constrained countries in the Global South, like South Africa, where there have been historical and ongoing multiple traumas, need interventions for healing and wellness that are low cost and can be replicated.

Postdigital health practices: new directions in medical humanities.

Digitalisation has changed the way we understand and practice health. The recent pandemic has accelerated some of the developments in digital health and brought about modifications in public access to information. Taking this into consideration, this programmatic paper sets the stage for and conceptualises postdigital health practices as a possible field of inquiry within medical humanities. While delineating some central aspects of said practices, I draw attention to their significance in contemporary strategies of knowledge production. Spotlighting online environments as the point of ingress for the analysis of these practices, I propose three possible foci of critical and methodological engagement. By spotlighting the serialisation, multimodality, and transmediality of such environments, I argue, we have a chance to both augment and go beyond the field's long-standing preoccupation with narrative, attend to various strategies of communicating illness experience, and re-frame them within larger questions of systemic inequalities. On this basis, and taking as examples COVID-19 and Long COVID, I sketch some of the directions that future strands of medical humanities may take and some of the questions we still have to ask for the field to overcome its own biases and blind spots.

Forensic rhetoric: COVID-19, the forum and the boundaries of healthcare evidence.

The COVID-19 pandemic has brought into sharp focus the shifting role of healthcare evidence in public health presentations. This article investigates the rhetoric of those presentations as a phenomenon indicating both the commitment to evidence-based public health messaging and its political loading in three interlinked case studies: computer-generated imagery ; 'podium' presentation and the NSO Fleming leak of COVID-19 contact tracing data. The pandemic has seen healthcare evidence attain ever-greater visibility in public forums, and those forums have themselves undergone rapid transformation. 'Podium' presentations such as press conferences have featured colourful imagery, and the manifold visualisations of SARS-CoV-2 which have accompanied television broadcasts and web pages display an insistent internal rhetoric. I analyse both forms of rhetoric for what they say about the 'forensic' moment created by COVID-19, and evaluate each in relation to Weizman's conception of the forum, which enables both 'frontstage' corporate and governmental image-building and public scrutiny. This paper evaluates the politics of the presentational strategies which have arisen around COVID-19 and the ethical potential of the forum.

Does medical humanities matter? The challenge of COVID-19.

Medical humanities has tended first and foremost to be associated with the ways in which the arts and humanities help us to understand health. However, this is not the only or necessarily the primary aim of our field. What the COVID-19 pandemic has revealed above all is what the field of critical medical humanities has insisted on: the deep entanglement of social, cultural, historical life with the biomedical. The pandemic has been a time for reinstating the power of expertise of a particular kind, focusing on epidemiology, scientific modelling of potential outcomes and vaccine development. All of this delivered by science at speed.It has been challenging for medical humanities researchers to find purchase in these debates with insights from our more contemplative, 'slow research' approaches. However, as the height of the crisis passes, our field might now be coming into its own. The pandemic, as well as being productive of scientific expertise, also demonstrated clearly the meaning of culture: that it is not a static entity, but is produced and evolves through interaction and relationship. Taking a longer view, we can see the emergence of a certain 'COVID-19 culture' characterised by entanglements between expert knowledge, social media, the economy, educational progress, risk to health services and people in their socio-economic, political ethnic and religious/spiritual contexts. It is the role of medical humanities to pay attention to those interactions and to examine how they play out in the human experience and potential impact of the pandemic. However, to survive and grow in significance within the field of healthcare research, we need to engage not just to comment. There is a need for medical humanities scholars to assert our expertise in interdisciplinary research, fully engaged with experts by experience, and to work proactively with funders to demonstrate our value.

Understanding the value of art prompts in an online narrative medicine workshop: an exploratory-descriptive focus group study.

Narrative medicine is an interdisciplinary field that complements and expands on conventional healthcare training by supporting narrative competence skills and creativity derived from the arts and humanities domains to address the needs of healthcare providers and receivers. With the COVID-19 pandemic having had a profound impact on the healthcare workforce with an already high burn-out rate, multimodal arts interventions may help address the holistic dimensions of well-being. While empirical evidence supports the use of arts-based interventions in promoting healthcare workers' well-being and personal growth, art prompts are underexplored and underused in narrative medicine. Moreover, protocols and frameworks adopted in extant research on this topic are inconsistent, resulting in replication and validation challenges. These issues have motivated this exploratory-descriptive study with 11 narrative medicine practitioners to examine the use of short art prompts in an online narrative medicine workshop.The art prompts leveraged art therapy's Expressive Therapies Continuum (ETC) model, which uses the inherent properties of art materials, media and methods to elicit specific levels of information processing and creative experiences. The study aimed to understand how art prompts differ from writing prompts and explore the value art prompts could add to narrative medicine if any. Qualitative analyses revealed that art prompts in narrative medicine increase positive feelings and promote creativity and insight. Specifically, art prompts allowed participants to use sensorimotor functions, enter a flow-like state, be challenged and inspired by novelty and uncertainty, and experience a sense of play and personal discovery.

"I am not alone with tears": embodying stigma and longing among youth living with perinatally acquired HIV in Tanzania through a collaborative arts-based approach.

It is estimated that 4 million youth aged 15-24 years live with HIV globally, 85% of whom live in sub-Saharan Africa. For youth living with perinatally acquired HIV (YPHIV), stigma is frequently linked with negative health outcomes. YPHIV face distinct HIV stigma experiences across the lifespan, particularly because of the centrality of the family context in their HIV experience and the reality that they have lived with HIV since birth. Nevertheless, our understanding and measurement of stigma remains limited. One way to improve our understanding of HIV stigma for YPHIV is through in-depth exploration of embodied narratives of HIV experience. This paper is based on fieldwork that incorporated a collaborative arts-based approach with a group of six YPHIV in Tanzania. Using artwork and a theoretical framework of embodiment, this paper phenomenologically describes their narratives of HIV experience, perceptions of stigma over time and imaginations of the future. This paper highlights that collective solidarity, habitus and participants' desire to reframe others' perceptions about them and relieve the suffering of others shape the embodied experience with HIV. Moreover, this paper argues that stigma experiences for YPHIV are temporal and have changed over time with increased age, interventions and biomedical advances. Broadly, while HIV stigma continues to exist, participants report responding to stigma with agency by creating alternative solidarities and pushing boundaries of possibility, reframing others' perceptions of them and acting on dreams for better futures.

Visual intelligence education using an art-based intervention: Outcomes evaluation with nursing graduate students.

BACKGROUND: Purposeful visual training is effective. Increasingly, visual arts learning interventions are used by multiple disciplines to improve observation and communication skills, critical skills in healthcare. PURPOSE: The primary aim was to evaluate enhancement of skills in the observation, perception and communication domains of visual literacy following a fine arts intervention with nursing graduate students. METHODS: An art-based intervention with five visual thinking activities was collaboratively developed with a faculty director of an arts and humanities program and museum arts educator and implemented at a gallery with 94 Post-Master's Doctor of Nursing Practice (DNP) students in advanced roles and Clinical Nurse Leader (CNL) entry-to-practice graduate students. Participation in the non-randomized, non-controlled quantitative study with pre- and post-evaluation design was voluntary. Prior to and following the session, 63 participants completed a Visual Intelligence Assessment (VIA) tool and 70 completed an Image Assessment exercise. RESULTS: Pre-intervention scores were similar for the two groups. Post intervention, DNP VIA mean scores increased from 3.58 to 3.68 (p = .057) while CNL mean VIA scores decreased from 3.65 to 3.53 (p = .08). DNP students had significantly higher image scores post-intervention (p < .001), demonstrating improved use of objective language. No difference was found in CNL image scores pre and post. CONCLUSIONS: The intervention increased self-awareness and perceived understanding of the role of VI on perception and empathy. DNP students also improved observational skills and language. Magnitude and direction of change in self-awareness appears relative to prior experience and skill.

Aesthetics for everyday quality: one way to enrich healthcare improvement debates.

In this paper we seek to illuminate the importance of aesthetics for healthcare quality and encourage more explicit discussion of aesthetics in healthcare improvement scholarship and practice. We hope to contribute to and help develop the hinterland between arts-based initiatives in healthcare and the 'normal business' of healthcare quality improvement. Our broad contention is: (1) That aesthetic considerations should be seen as of universal relevance across quality debates (2) That they never be assumed to have a marginal or even secondary status; and (3) That taking aesthetic considerations seriously calls for explicit discussion of associated uncertainties and dilemmas and a readiness to welcome aesthetics expertise into improvement debates.

Health, well-being, and material-ideal hybrid spaces in Yeats's writing.

Traditionally regarded as high-art, poetry is often seen as a superior form of literary achievement consecrating in verse worldviews and lives connected to ideal, transcendental realms, the pursuance of which supposedly leads to some kind of ideal health and spiritual well-being. The poet WB Yeats (Nobel Prize in Literature, 1923), who believed in the power of poetry to reveal realities and states of such perfection, thereby giving purpose to mundane life, likened this effect of poetry to the fashioning of statues as monuments of unageing intellect. However, contradictorily, he also questioned the value of poetry thus conceived by questioning whether it is healthy to aspire to embody poetically consecrated ideals in real life. Yeats's dilemmatic negotiation between these two positions suggests that better personal well-being can be achieved in living an enlightening life by being mindful of the body's sensuality and materiality. In poetic explorations of the ways in which idealism and sensuality can affect how we live our lives, Yeats used real-life examples of people he knew, often important public figures in Irish social and political history.The present paper frames these explorations in terms of Yeats's concepts of living stream and stone/statuary, augmented with Bruno Latour's concepts of traditional subject and articulated body, discussed in relation to purpose in life and closeness and empathy, proposing that an overly idealistic 'poetic' lifestyle can have adverse effects, whereas poetry that increases one's awareness of oneself as articulated body is conducive to better health and well-being.

Pine fresh: the cultural and medical context of pine scent in relation to health-from the forest to the home.

Pine is a familiar scent in domestic cleaning products, but how often do we relate it to its origins as an odour emanating from a tree? This article takes a sensory history approach to trace the late 19th century and early 20th century use of the pine forest as a therapeutic space, via the tuberculosis sanatoria to the use of pine scent in domestic disinfectant. By focusing on pine as experienced in this period as a microhistorical subject, this methodology will in turn allow for a detailed consideration of how historical context, and in particular medical conceptions and health concerns, can influence the creation of cultural memory. By following the trajectory of pine from its place in the forest to a commercial product used in the home, this will allow for an investigation at the intersection of environmental and medical histories and provide a framework for the consideration of the relationship of place to senses associated with concepts of health and well-being. As interest grows in the development of more effective sensory settings, in particular within healthcare, it also highlights the importance of considering the roles both cultural and personal memory play in response to various sensory stimuli.

Complexities in interdisciplinary community engagement projects: some reflections and lessons from an applied drama and theatre project in diabetes care.

There is a growing interest in using drama techniques and theatrical performance to disseminate health information to lay audiences as part of community engagement projects. This process can be challenging for a number of reasons, however. In this paper, we describe the process and pitfalls of an interdisciplinary project involving the development and performance of a play about diabetes mellitus. The play formed part of a long-term, three-way community engagement project between social science, applied drama and a diabetes clinic in South Africa. Building on a framework derived from a number of applied drama methods, we elicited narratives from key 'storytellers' that were developed and embodied by actors in a new performance called Blood Sugars Creating this play provided insight into working in an interdisciplinary space and highlighted the importance of establishing shared goals and joint ownership of the project right from the outset. This was without doubt a challenging project and the complexities of finding common ground across three disciplines are not to be underestimated. In this paper, we explore the collaboration and its challenges, drawing on the framework of complexity theory. In particular, we examine the layers of complexity that emerged as a result of the interdisciplinary nature of the project and the demands of balancing the authenticity of the stories with the perceived requirements of health messaging. We consider the methodological, conceptual and ethical challenges of this type of research, and discuss some recommendations for teams taking on similar complex multidisciplinary research and intervention projects.

Changes in emotions and perceived stress following time spent in an artistically designed multisensory environment.

Self-management strategies that enhance positive emotions are considered most effective to cope with stress and maintain good mental health and well-being. An artistically designed multisensory environment, The Sensory-Art Space (SAS), was installed in a university in NSW Australia as a new self-management intervention. The design of the SAS was informed by evidence regarding the benefits of viewing art, experiencing nature and accessing sensory rooms.A pilot pre-post intervention study measured changes in affect and perceived stress in 224 participants who spent time in the SAS. Descriptive statistics were completed on the individual affective states, and paired sample t-tests were used to determine changes in Positive and Negative Affect (PANAS-X) and perceived stress (Visual Analogue Scale).The Wilcoxon signed-rank test showed that negative affect reduced, z=-10.23 (p<0.001), and positiveaffect increased, z=-2.57 (p=0.01), following spending time in the SAS. In addition, stress levels reduced after time spent in the SAS, z=-11.29 (p<0.0001).Self-management benefits were found following time in the SAS and future implications for public health and well-being are discussed.

The rationales for and challenges with employing arts-based health services research (ABHSR): a qualitative systematic review of primary studies.

Health services research (HSR) is an interdisciplinary field that investigates and improves the design and delivery of health services from individual, group, organisational and system perspectives. HSR examines complex problems within health systems. Qualitative research plays an important role in aiding us to develop a nuanced understanding of patients, family, healthcare providers, teams and systems. However, the overwhelming majority of HSR publications using qualitative research use traditional methods such as focus groups and interviews. Arts-based research-artistic and creative forms of data collection such as dance, drama and photovoice-have had limited uptake in HSR due to the lack of clarity in the methods, their rationales and potential impacts. To address this uncertainty, we conducted a qualitative systematic review of studies that have employed arts-based research in HSR topics. We searched four databases for peer-reviewed, primary HSR studies. Using conventional content analysis, we analysed the rationales for using arts-based approaches in 42 primary qualitative studies. We found four rationales for using arts-based approaches for HSR: (1) Capture aspects of a topic that may be overlooked, ignored or not conceptualised by other methods (ie, quantitative and interview-based qualitative methods). (2) Allow participants to reflect on their own experiences. (3) Generate valuable community knowledge to inform intervention design and delivery. (4) Formulate research projects that are more participatory in nature. This review provides health services researchers with the tools, reasons, rationales and justifications for using arts-based methods. We conclude this review by discussing the practicalities of making arts-based approaches commensurable to HSR.

Can Death Cafés resuscitate morale in hospitals?

Death Cafés are non-profit social franchises that arise spontaneously in communities to serve as informal forums for discussing death. There is a great need within the medical community for the kind of conversation that Death Cafés foster: open, unstructured, spontaneous, genuine and interdisciplinary dialogue. Burnout in healthcare, with symptoms of exhaustion, depersonalisation and decreased efficacy, is a global crisis, with alarming estimates suggesting one in three practicing physicians experience burnout. While open-forum community-based Death Cafés exist widely, there appears to be no evidence in the literature to suggest that healthcare settings have adapted this model for fostering debriefings among hospital employees. We have started hospital-based Death Cafés in a large, public, urban-centre, Level I Trauma centre in the Gulf South in an effort to study healthcare worker burnout. In this brief commentary, we introduce the concept of hospital-based Death Cafés as distinct from community-based Death Cafés. From our experience, hospital-based Death Cafés are easy to implement, inexpensive, require little planning and yet offer tremendous reward to participants. Should the phenomenon of Death Cafés take off in hospitals as it has in communities internationally, we propose that this intervention be studied for its effect on healthcare worker burnout.

Bibliotherapy in practice: a person-centred approach to using books for mental health and dementia in the community.

Bibliotherapy is the use of texts to provide support for people with mental and physical health problems. It is widely seen to have beneficial outcomes but there is still disagreement about how best to deliver bibliotherapy in practice. This article explores one method of delivering bibliotherapy which has evolved over the past 20 years in the North of England, the Kirklees approach. Using a multimethod qualitative research design including reflective observations, interviews and document analysis, the article examines how bibliotherapy has been delivered to people with mental health problems and dementia in a volunteer-led scheme. As an inherently flexible and adaptable approach, bibliotherapy in practice in Kirklees is best defined by its ethos, rather than a prescriptive list of its activities, as is the case for many alternative approaches to bibliotherapy. It is an approach to bibliotherapy which is person-centred; avoids value judgements of texts and responses to them; is often co-produced with group participants; is about making a contribution (in a variety of ways); and emphasises social connection. This separates it from other current models of bibliotherapy operating in the UK, and demonstrates how it may be tailored to the requirements of those experiencing diverse mental and physical health conditions. A more responsive form of bibliotherapy, as outlined here, has the potential to provide support across the community.

'The Internet Both Reassures and Terrifies': exploring the more-than-human worlds of health information using the story completion method.

Lay people are now encouraged to be active in seeking health and medical information and acting on it to engage in self-care and preventive health practices. Over the past three decades, digital media offering ready access to health information resources have rapidly expanded. In this article, I discuss findings from my study that sought to investigate health information practices by bringing together the social research method of story completion with more-than-human theory and postqualitative inquiry. Narratives of health, illness and embodiment are powerful ways to portray people's experiences and identify the shared cultural norms and discourses that give meaning and context to these experiences. The research method of story completion is a novel approach to eliciting narratives that involve participants' responses to hypothetical situations. Participants were asked to use an online questionnaire format to complete three stories involving characters faced with a different health problem. This approach sought to identify the human and non-human enabling resources with which the characters engaged as they tried to address and resolve their problem, with a particular interest in how both digital technologies and non-digital resources were used. This analysis highlighted the affective and relational dimensions of humans' enactments of health, illness and embodiment. The stories surfaced the relations of sense-making, embodiment and care and how they are distributed between humans and non-humans. Agential capacities were closed off by elements such as too much information online creating confusion or anxiety, self-consciousness about the appearance of one's body, feelings of embarrassment and shame, or not wanting to appear to be too weak or vulnerable. Capacities for change, wellness and recovery were opened by finding helpful information, making connections with others and finding therapeutic spaces and places.