Purpose: To evaluate the long-term effects of an Arts on Prescription (AoP) programme on sense of coherence (SOC) in Sweden.

Design: A controlled intervention study with a quasi-experimental prospective design, including questionnaires at baseline, with follow-ups at 6 and 12 months. Participants were on sick leave due to common mental disorders (CMD) and/or non-specific musculoskeletal pain, recruited from primary care in six regions. The intervention group also included participants from open psychiatric care. The study sample comprised 586 participants (335 in the intervention group and 251 in the control group).

Results: Both groups showed a significantly stronger SOC at follow-up, with a medium effect size for the intervention group and a small effect size for the control group. No statistically significant difference in SOC change over time was observed between the groups. Participants from open psychiatric care in the intervention group showed a significant improvement in SOC compared to those from primary care. Concerns about finances had a significant main effect on SOC for the entire study population.

Originality: Unlike most AoP studies, this controlled study with a relatively large sample provides insights into the long-term effects of AoP on SOC, with results reported using p-values and effect sizes.

BACKGROUND: Dance classes for people with Parkinson's Disease (PD) are offered worldwide; however, further studies are needed to explore patients' experiences of how dance affects well-being.

PURPOSE: To explore how Dance for Parkinson (Dance for PD) is experienced, and how it contributes to the well-being and health of participants in Sweden.

METHODS: This qualitative study collected data from four focus groups. Participants were asked how dance classes impacted their well-being, and their ability to perform activities of daily life. The focus groups were recorded and transcribed. Data were analysed using content analysis, meaning units were coded, and codes were coalesced into categories from which themes were abstracted.

RESULTS: Dance for PD provided a multifaceted experience related to social relationships, aesthetic context, feelings of wellbeing and the physical experience of dancing. The main theme contained four sub-themes: Connectedness, Pleasure and glamour, Well-being in mind and body and Customized movements.

CONCLUSION: The present study highlights that health and well-being are improved by Dance for PD. It is an enjoyable activity that meets the specific needs of persons living with the consequences of PD and should therefore be promoted by occupational therapists.

Common mental disorders (CMD) and non-specific musculoskeletal pain have a major impact both on individual well-being and societal burden. Anxiety and depressive disorders are widespread, leading to high levels of sick leave, especially among women. Arts activities are increasingly recognised as a means of promoting health for individuals with CMD and of helping to manage long-term pain.

This thesis examines whether, and if so, how and to what extent Arts on Prescription (AoP) can serve as a health-promoting programme for individuals on sick leave due to common mental disorders (CMD) and/or non-specific musculoskeletal pain. It comprises three quantitative studies employing a quasi-experimental prospective design, with baseline assessments and follow-ups at 6 and 12 months, alongside one qualitative study based on focus groups.

Results in Study I showed significantly greater reductions in depression over time in the intervention group compared to the control group. However, this difference was not maintained after adjusting for sick leave. The within-group change over time for stress, anxiety, and depression was significant for both groups, with a larger effect observed in the intervention group compared to the control group, regardless of the adjustment for sick leave. The results of Study II indicated no statistically significant difference between the groups in the change in sense of coherence (SOC) strength over time. Both groups demonstrated statistically significant within-group increases in SOC, with the intervention group exhibiting an effect size that was double that of the control group. This reflected a medium effect size for the intervention group compared to a small effect size for the control group, regardless of whether sick leave adjustments were made. No statistically significant results were found in Study III regarding changes in general self-efficacy (GSE), either for between-group or within-group differences over time. The estimated effect size for within-group changes in GSE over time was small in both the intervention and control groups. Descriptive statistics on the effect of sick leave status revealed a significant difference in general GSE across various levels of sick leave. Participants on 25% sick leave had the highest GSE values, while those on full-time sick leave reported the lowest GSE values. Financial concern and educational level served as indicators of social determinants of health and health inequalities in the analyses. Descriptive statistics in Studies I-III revealed that participants frequently concerned about finances reported higher stress, anxiety, and depression levels (Study I), alongside the weakest SOC (Study II) and the lowest GSE (Study III). In contrast, those never concerned about their finances exhibited lower stress, anxiety, and depression, the strongest SOC, and the highest GSE. This difference encompassed all SOC sub-dimensions, Comprehensibility, Manageability, and Meaningfulness, while Meaningfulness remained stable in other analyses across Studies I-III. Conversely, educational level showed no significant effect. These findings suggest that financial concern can be a critical factor influencing mental health and well-being. In Study IV, the findings indicate that the participants' involvement in AoP fostered a sense of belonging, relief from daily demands, and a feeling of being moderately challenged through the arts activities. These challenges, when embraced, led to a sense of reward manifested as increased confidence and self-efficacy as the participants perceived they had successfully performed the arts activities. Together, these experiences contributed to health-promoting changes within the individual, such as transformed perceptions of their abilities, increased self-respect, and regained motivation and hope for the future

Aims: Involvement in arts has shown potential to promote mental health. Thus, arts may be able to complement conventional healthcare to address common mental disorders (CMD). The aim of this study was to evaluate the long-term effect of a 10-week Arts on Prescription program regarding CMD (stress, anxiety, depression), compared to conventional healthcare. The study also aimed to examine whether CMD differed between groups.

Methods: A quasi-experimental prospective design with intervention and control group and 6- and 12-month follow-up was used to evaluate an Arts on Prescription program in Sweden, focusing on the effects on stress, anxiety, and depression. Participants were on sick leave due to CMD and/or musculoskeletal pain. Data was collected using questionnaires.

Results: The study population consisted of 479 participants (n=247 intervention group, n=232 control group). The result indicates a greater effect size (ŋ) in the intervention group compared to the control group for reduction in stress, anxiety, and depression at follow-up after 12 months. The difference in depression was significant.

Conclusions: The results indicate AoP could be an adjunct to conventional healthcare interventions to address CMD, especially depression.

I dag lever över 130 000 personer med en demenssjukdom i Sverige och antalet ökar. Att delta i mentalt stimulerande aktiviteter kan vara ett sätt att hantera dagliga utmaningar och anpassa sig till minnesproblematik. Demens berör inte bara de som insjuknar utan också deras anhöriga och det finns ett behov av att erbjuda aktiviteter där även anhöriga inkluderas. Ett exempel på en mentalt stimulerande aktivitet för personer med demens och deras anhöriga är den anpassade konstvisningen Möten med minnen som bedrivs på flera museer i Sverige. Visningarna sker i grupp och innebär att titta på och utbyta tankar om konst eller föremål, och associera till egna upplevelser, utifrån olika teman. Förutom konstrelaterade ämnen kan visningarna också utgå från till exempel bygdehistora och bruksföremål. Syftet med föreliggande studie var att utvärdera om en visningsaktivitet i grupp inom hembygdsföreningar kan påverka sinnesstämning hos personer med mild eller medelsvår demens. Vidare var syftet att utvärdera anhörigas upplevelser av gruppaktiviteten. Rekrytering av deltagare skedde genom personal från demensteam i kommunal verksamhet och regionsjukvård. Totalt bestod studien av nio personer med demenssjukdom och nio anhöriga, som också var partners, till dessa personer. Första visningsaktiviteten startade september 2019 på Norrahammars industri-och bygdemuseum och fortsatte januari 2020 samt oktober 2021 i Aneby Hembygdsförening. Grupperna träffades en gång i veckan under tre veckor och varje träff varade två timmar. Föremål och tavlor som gestaltade vardagen förr i tiden presenterades för deltagarna och gruppledarna uppmuntrade deltagarna att associera till föremålen och minnas hur de hade använts. För att ta reda på om visningsaktiviteten hade någon inverkan på sinnesstämningen observerades personerna med demens samt att de själva fick skatta sitt stämningsläge före och efter aktiviteten. Förutom att de anhöriga också skattade sitt stämningsläge, deltog de också i en intervju. Resultatet visade att både personer med demens och deras anhöriga var gladare efter visningsaktiviteten än före. Personerna med demens visade också aktivt intresse och positiva känsloyttringar under de två timmarna som visningsaktiviteten pågick. De anhöriga uppskattade att göra en aktivitet utanför hemmet och att få göra något tillsammans med sin partner. På grund av kognitiv svikt var behållningen för personerna med demens oftast bunden till stunden, men projektet visade ändå på ett givande sätt att öka både sinnesstämningen och relationen mellan partnerna.

Arts on Referral (AoR) is a complementary intervention used to support people who are on sick leave due to common mental disorders (CMD) and/or musculoskeletal pain, challenging public health.

Aim: To deepen the understanding of how AoR works from a health-promoting perspective and how people with CMD and/or musculoskeletal pain experience AoR.

Design: The study adopted a qualitative approach. Thirty women (21–65 years old) participated in a total of five focus groups after the AoR intervention, which consisted of two sessions a week for ten weeks.

Findings: A qualitative content analysis of the focus group identified four categories: 1. Place of belonging including descriptions of social connectedness and understanding; 2. Experiences of AoR as a respite from demands; 3. Arts activities offering challenge and reward; and 4. Contributing to health-promoting changes. The findings were discussed in the light of Wenger’s concept of community of practice and Csikszentmihalyi’s concept of flow.

Value: This study describes how AoR contributed to health-promoting changes by offering a place of belonging, free from demands but still with opportunities to challenge oneself and explore new skills. Findings suggest that AoR can be helpful in improving mental wellbeing and feelings of belonging.

Background: It is well recognized that long waiting times at Emergency Departments (ED) influence patient satisfaction rates. Evidence suggests that changes in the design of healthcare environments can improve patient care when these changes include the provision of nature and music elements in different ways.

Aim: To explore how patients, relatives and staff perceive a slideshow with nature pictures and music in the emergency department waiting room.

Method: A descriptive survey design including a slideshow with nature pictures and music shown in the waiting room. Questionnaires were distributed to patients and relatives (n=94) as well as to the staff (n=76), analysed with descriptive statistics and content analysis.

Results: A majority (67%) of the participants thought that the slideshow contributed to a positive environment in the waiting room. Content analysis of 254 comments demonstrated it to be experienced as relaxing and calming. There is, however, room for improvement regarding quality, length and variation of the slideshow.

Conclusion: An organized wait time with different alternative activities including nature elements and music in the waiting environment may have positive impacts. The challenge lies in creating a supportive design, which supports the three separate groups and their needs for control in terms of freedom of choice and variation.

There is a demand for interventions aimed at adolescent girls with psychosomatic problems. In 2013, positive results were reported from a dance intervention programme addressing girls with internalizing problems. The research team behind the intervention immediately received requests from municipalities and county councils interested in using the intervention. From an implementation point of view it is unclear what made the intervention spread without an active plan. The aim of this study was to explore adopters' experiences about the diffusion and initiation of a public health intervention targeting adolescent girls with internalizing problems. Interviews were conducted with 12 people who were engaged in initiating the intervention in different settings. Data were analysed using conventional content analysis, yielding three categories: perceived appeal and trustworthiness, convenient information, and contextual factors. The results reflected that the participants found that there was a need for an intervention and found the dance intervention to be evidence based and not too complex to perform. Further, there was available information on the project which could easily be distributed to decision makers and others. When initiating the intervention, factors related to economy, possibility for collaboration and recruitment were of importance.