HEARTS. The Health, Economic and Social impact of ARTS engagement: a Public Health Study

在过去的几十年里，国际上对艺术和文化在个人和社区层面上在保健、公共卫生和促进健康方面的作用产生了极大的兴趣。然而，绝大多数的研究都集中在有针对性的、有时间限制的艺术干预对特定患者群体的影响上。然而，英国各地的许多艺术和文化参与并不局限于具体的干预措施，而是涉及更普遍、无处不在的参与，这种参与可能更难通过实验研究来衡量。一些选定的公共卫生研究发现，文化参与（包括参加音乐会、博物馆和画廊）与自我报告的健康状况之间存在关联，文化参与与死亡风险之间存在负相关。然而，重要的问题仍然存在，到目前为止，还没有大规模的公共健康研究来检查艺术在英国的影响。该项目由表演科学中心领导，该中心是皇家音乐学院和伦敦帝国理工学院的国际独特合作伙伴关系，在艺术，健康和社会研究方面有着广泛的记录。它探讨了(i)需要积极“做”的活动（如音乐、舞蹈、艺术、摄影和戏剧）和（ii）需要实际参加的活动（如参加音乐会、纪念碑、博物馆、画廊、电影院、文物档案馆和剧院）的影响；（iii）“以家庭为基础”的活动（例如，听广播、看电视、阅读、讲故事、使用基于艺术的应用程序、数字艺术体验、在线音乐联合制作）。我们的研究问题确定了艺术和文化对个人、社会和经济健康和福祉的影响，以及探索英国不同社会经济、地理和种族人口之间的关联是如何变化的。为了探索这些问题，该项目被组织成四个工作包。工作包1将涉及评估现有数据，包括对以前的研究进行荟萃分析，并探索一项英国队列研究，其中包括一些关于艺术的问题。然而，认识到目前可用的数据有限，工作包2和3是基于在我们的研究期间进行的大规模全国调查。该调查对英国所有成年人开放，调查对象包括普通人群以及被诊断患有英国面临的四种主要健康状况之一的参与者：心理健康、癌症、心血管疾病和慢性呼吸道疾病。这些条件以前都在较小的健康艺术干预研究中进行过研究，但没有在公共卫生层面进行研究，将它们纳入将有助于理解文化与健康和福祉的个人、社会和经济方面之间的关系。总共将招募25,000名参与者完成一份匿名在线问卷，其中包括人口统计问题、经过验证的心理量表和经济指标、对艺术和文化参与的评估以及健康状况的自我报告。工作包2将通过嵌套病例对照研究对这些数据进行横断面分析来探讨这些问题；工作包3将监测样本的一小部分作为下一年的队列，每6个月更新一次，以跟踪艺术参与的纵向变化。认识到文化参与和健康的复杂性，工作包4将为调查数据添加背景，调查参与者的子样本参加定性电话访谈，以探索英国各地艺术参与的动机和经验，以及如何报告这与健康行为，观念和结果的交叉。通过提出的广泛的流行病学方法，雄心勃勃的样本量和嵌套的定性数据，研究结果有望重新定义艺术和文化对英国公共卫生的价值。

In the past few decades, there has been a surge of international interest in the role of the arts and culture in healthcare, public health and health promotion, on an individual and community level. However, the vast majority of research studies have focused on the effects of targeted, time-limited arts interventions on particular patient groups. Yet, much of the arts and cultural engagement across the UK is not confined to specific interventions but involves a more general, ubiquitous participation that can be harder to measure through experimental studies. A select number of public health studies have found associations between cultural participation (including attending concerts, museums and galleries) and self-reported health, as well as inverse associations between cultural participation and mortality risk. However, important questions remain, and to date, there have been no large-scale public health studies examining the impact of the arts in the UK.This project is led by the Centre for Performance Science, an internationally distinctive partnership of the Royal College of Music and Imperial College London, with an extensive track record in arts, health and social research. It explores the effect of (i) activities that involve actively 'doing' (e.g. music, dance, art, photography and drama) and (ii) activities that require physical attendance (e.g. attending concerts, monuments, museums, galleries, cinemas, heritage archives and theatre); (iii) 'home-based' activities (e.g. listening to the radio, watching TV, reading, storytelling, using arts-based apps, digital arts experiences, online music co-production). Our research questions identify the impact of the arts and culture on individual, social and economic measures of health and wellbeing, as well as explore how associations vary between different socioeconomic, geographical and ethnic populations within the UK.To explore these questions, the project is organised into four work packages. Work package 1 will involve assessing existing data including undertaking a meta-analysis of previous studies and exploring a UK cohort study that includes some questions on the arts. However, recognising the limited data currently available, work packages 2 and 3 are based on a large-scale national survey to be carried out during our study. Open to all adults in the UK, the survey will target the general population as well as participants diagnosed with one of four major health conditions facing the UK: mental health, cancer, cardiovascular disease and chronic respiratory diseases. These conditions have all previously been researched in smaller arts-in-health intervention studies but not at a public health level, and their inclusion will facilitate understanding of the relationships between culture and the individual, social and economic facets of health and wellbeing. A total of 25,000 participants will be recruited to complete an anonymous online questionnaire consisting of demographic questions, validated psychological scales and economic metrics, assessments of arts and cultural participation and self-reporting of health. Work package 2 will explore the questions with a cross-sectional analysis of these data with nested case-control studies; work package 3 will monitor a sub-section of the sample as a cohort for the following year with 6-monthly updates to track longitudinal change in arts engagement. Recognising the complexity of cultural engagement and health, work package 4 will add context to the survey data, with a sub-sample of survey participants taking part in qualitative telephone interviews to explore motivations for, and experiences of, arts engagement across the UK and how this is reported to intersect with health behaviours, perceptions and outcomes.Through the extensive epidemiology methods proposed, an ambitious sample size and nested qualitative data, the findings promise to redefine the value of the arts and culture for public health in the UK.