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Understanding wellbeing outcomes in primary care arts on referral interventions: a mixed method study

Samantha Hughes, Diane M Crone, Rachel C Sumner, Mark Redmond


Background: Arts on Prescription programmes are designed to support the mental health and wellbeing of patients with a variety of clinical needs within the community. Despite a number of studies reporting benefits, there are some patients that do not see improvements in their wellbeing. Yet, there is limited research investigating the reasons for this. The present study aimed to address this deficit.

Methods: Using a sequential mixed-methods design the present study sought to understand why some participants (N=312) experienced an increase in wellbeing and others did not (N=95) after attending an Arts on Prescription intervention based in the South West of England between 2009 and 2016.

Results: Quantitative comparisons between the 2 groups identified little differences, aside from age and baseline wellbeing (WEMWBS scores), with those that improved being slightly younger and having lower wellbeing at the outset compared with those that did not improve. A process model depicting the perceived facilitative and inhibitive factors of attending the programme was developed from the qualitative findings. This model suggests that the social aspect of the course may be implicated in the participants differential outcomes with those that showed a decrease in wellbeing reporting difficulties in interacting with others during the intervention. Further, the participants who reported an increase in wellbeing felt vulnerable to “relapse” when finishing the course due to uncertainties regarding future support and their ability to maintain their wellbeing without the provision of the programme.

Conclusions: The results of our research suggest a need to promote communication among groups in such interventions with the hope that this will provide a more facilitative environment for all participants to benefit. Also, such programmes should consider follow-on options to ensure the participants feel supported and confident in managing their wellbeing once the course comes to an end. Our findings are pertinent to those commissioning primary care art interventions, ensuring that referral policies and pathways are designed for optimal effectiveness and for potentially tailoring social prescribing programmes to suit the participants’ specific needs.


Arts for health, holistic health management, mental health, mixed methods, person-centered healthcare, primary care, social prescribing, wellbeing

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