III Researching arts in health interventions
An introduction to research
In 2011, journalist Eryn Brown wrote an article in the Los Angeles Times entitled ‘ “Duh” science: Why researchers spend so much time proving the obvi- ous’.(1) She discussed the issue of why medical researchers who have unlocked the human genome and wiped out smallpox also engage in ‘the practice of hypothesising, testing and publishing the seemingly obvious’. Similar to the examples Brown cites in her article, many research questions in arts in health might appear to have answers so obvious they need not be researched: of course relaxing music calms anxiety in pre-surgical patients; it stands to reason that providing artwork in waiting areas can help to alleviate boredom; and it’s clear that weekly dance classes lead to improved strength in older adults. However, as Brown acknowledges, research is vitally important even for seemingly obvious research questions for a range of reasons, including:
- 1. Confirmation—However obvious something seems in theory or anecdote, it may not be true in practice. A study published in the journal Injury Prevention in 2000 looked at whether toughened glasses led to reduced injuries in bars.(2) On the surface, stronger pint glasses logically sound a sensible idea as they will be less likely to smash. However, the study found that people were less careful with toughened glasses and there were in fact nearly double the number of injuries; the exact opposite of what the researchers had hypothesized. This example illustrates how perceived truths or anecdotal reports are insufficient in determining whether an effect is likely to occur and research is needed, even on apparently obvious questions
- 2. Influence—To influence perceptions and policy, there not only has to be proof but repeated proof, again and again. A famous example is the number of studies linking smoking and lung cancer that had to be published before there were significant changes in smoking legislation and public activity. To convince healthcare professionals, funders, and the public of the benefits of the arts, repeated research studies are needed to achieve a general scientific consensus. These may take the form of replications of previous studies to confirm findings, extensions of previous studies with larger groups or in different settings, or studies that approach the same question from different angles
- 3. Mechanisms—Even if the answer to the research question might appear simple, the mechanisms by which this effect is achieved can be complex. For example, for relaxing music to calm anxiety in pre-surgical patients, a cascade of activity must place, including activation of various parts of the brain, and release of a number of hormones and signals across vast networks of nerve cells. The resultant effect is also not confined to a feeling of lower anxiety but involves altered activity within certain organs such as lowered heart rate alongside changes in levels of biomarkers of the endocrine and immune systems.(3) There may be other implications too, such as changes in the levels of induction agents needed for the anaesthetic or reduced quantities of analgesics after surgery. Consequently, research turns the initial simple question as to whether music can reduce pre-surgical anxiety into a much richer topic and has the potential to demonstrate an even greater effect on patient care than initially anticipated
- 4. Variation—It is also important to take into account variation. Artistic experiences are individually, socially, and culturally informed, so a single intervention could have different effects on people of different ages, cultural and socioeconomic backgrounds, and health status. Again, research is vital for characterizing this variation both to understand how the arts can be best tailored to suit different populations and also to be realistic about the impact the arts can have with different participant groups
Consequently, sometimes arts in health research may on the surface address some quite basic or ‘common-sense’ questions. However, systematically investigating arts interventions through research is essential to understand the extent and nature of these effects, produce generalizable knowledge, and engage stakeholders, especially those who may be more cautious as to the potential benefits of the arts for health. Furthermore, not all questions are common sense. Many of the greatest strides forwards in the field have come about through research that has demonstrated benefits of arts engagement that had not previously even been considered to exist. So research can be one of the most powerful ways of supporting development in the field.