Christina Davies

The art of being healthy: a qualitative study to develop a thematic framework for understanding the relationship between health and the arts

Objective In recent years the health–arts nexus has received increasing attention; however, the relationship is not well understood and the extent of possible positive, negative and unintended outcomes is unknown. Guided by the biopsychosocial model of health and theories of social epidemiology, the aim of this study was to develop a framework pertaining to the relationship between arts engagement and population health that included outcomes, confounders and effect modifiers. A health–arts framework is of value to researchers seeking to build the evidence base; health professionals interested in understanding the health–arts relationship, especially those who use social prescribing for health promotion or to complement treatments; in teaching medical, nursing and health-science students about arts outcomes, as well as artists and health professionals in the development of policy and programmes. Design A qualitative study was conducted. Semistructured interviews were analysed thematically. Setting Western Australia. Participants 33 Western Australian adults (18+ years). Participants were randomly selected from a pool of general population nominees who engaged in the arts for enjoyment, entertainment or as a hobby (response rate=100%). Results A thematic analysis was conducted using QSR-NVivo10. The resulting framework contained seven outcome themes and 63 subthemes. Three themes specifically related to health, that is, mental, social and physical health, while economic, knowledge, art and identity outcomes were classified as health determinants. Within each theme, positive, negative and unintended outcomes (subthemes) were identified and categorised as relating to the individual and/or to the community. A list of confounding and/or effect modifying factors, related to both the arts and health, was identified. Conclusions Given the increasing pressure on health resources, the arts have the potential to assist in the promotion of health and healing. This framework expands on current knowledge, further defines the health–arts relationship and is a step towards the conceptualisation of a causal health–arts model.

Defining arts engagement for population-based health research: Art forms, activities and level of engagement

Background: The arts and health evidence base needs to be grounded by common terminology and concepts from which original research and comparative studies can be developed. The aim of this study was to elucidate terminology central to understanding the arts and health causal pathway by defining arts engagement via art forms, activities and level (magnitude) of engagement. Method: The study design was cross-sectional. International experts (n = 280) completed an online survey about the concept of arts engagement (response fraction 44%) to generate a list of art forms and activities. Responses were analysed using NVivo. Participating experts then completed a second survey to rate activities by level of engagement (response fraction 57%). Ratings were analysed via descriptive statistics and factor analysis. Results: Arts engagement can be defined by five art forms – (1) performing arts; (2) visual arts, design and craft; (3) community/cultural festivals, fairs and events; (4) literature; and (5) online, digital and electronic arts – and measured via 91 activities. ‘Active’ arts activities had higher levels of engagement than ‘passive’ activities. Conclusion: Study findings provide guidance about which art forms and activities should be included in population surveys and provide a measurement of exposure for use in studies investigating the relationship between arts engagement and health.

Foodbank of Western Australia’s Healthy Food for All

Purpose – In Australia, the Foodbank of Western Australia (Foodbank WA) has a reputation for being at the forefront of health promotion. The purpose of this paper is to describe Foodbank WAs innovative food bank plus approach of incorporating healthy lifestyle initiatives (i.e. nutrition and physical activity education) into its core food bank business, so as to target priority issues such as food insecurity, poor food literacy, overweight, obesity, poor nutrition and physical inactivity. Design/methodology/approach – A case study approach was utilised to explore Foodbank WAs Healthy Food for All® (HFFA) strategy. HFFA is a comprehensive state wide, school and community based strategy, including the School Breakfast Programme, Food Sensations® and Choose to Move initiatives, designed to promote healthy lifestyles to low socioeconomic and vulnerable groups – a major target group of food banks. Findings – Since its inception in 2007, the delivery of food, education and resources has increased across all o...

Which ecological determinants influence Australian children’s fruit and vegetable consumption?

This study investigated determinants of fruit and vegetable (F&V) consumption among regional and remote Western Australian (WA) children, using an Ecological Model of Health Behaviour. Semi-structured interviews were conducted with 20 key informants (Health Workers, Food Supply Workers, and School/Youth Workers) purposively sampled from across regional and remote WA. Interviews were transcribed, analysed thematically using QSR-NVivo 10 software, and embedded within an Ecological Model of Health Behaviour to demonstrate the multiple levels of influence on health. Key determinants of F&V consumption at the intrapersonal level included attitude and food literacy among children. Key interpersonal level determinants included role modelling and parental food literacy. Institutional determinants included health service provision, school nutrition education and food skill programs. F&V availability, community networks and health-promoting spaces were key themes affecting families at the community level. The public policy level influencer included implementation of a store policy within local food outlets. Study findings suggested participatory programs with an emphasis on parental involvement and role modelling could increase F&V intake among children living in regional and remote areas; while school curriculum linkages were essential for school-based programs. Policy makers should consider further investment in school food literacy programs and family programs that are delivered collaboratively. Further, support of local food supply options and support for healthy food policies in food outlets are critical next steps. This study contributes new knowledge to build the evidence base and facilitate the development of targeted strategies to increase consumption of F&V among children living in regional and remote areas.

Health in arts: are arts settings better than sports settings for promoting anti-smoking messages?

Aim: Tobacco smoking is a leading cause of preventable mortality and morbidity. Since 1991, the Western Australian Health Promotion Foundation (Healthway) has sponsored the arts and sport in exchange for cigarette smoke-free events, smoke-free policies and the promotion of anti-smoking messages (e.g. Quit, Smoke Free or Smarter than Smoking). As health promoters often look for innovative and effective settings to advocate health, and as the approach of sponsoring the arts to promote health to the general population is uncommon, the purpose of this study was to evaluate the effectiveness of ‘health in arts’ by measuring the cognitive impact (message awareness, comprehension, acceptance and intention) of promoting anti-smoking messages at arts events, and comparing findings to sports events, a more traditional health promotion setting. Method: A secondary analysis of the 2004–2009 Healthway Sponsorship Monitor data was conducted. A total of 12 arts events (n = 592 respondents) and 9 sports events (n = 420 respondents) sponsored by Healthway to promote an anti-smoking message were evaluated. The study was cross-sectional in design. Participants were residents of Western Australia aged 15 years or above and attended events as part of an audience or as a spectator. Descriptive and regression analyses were conducted. Results: After adjustment for demographic variables, smoking status and clustering, arts events were found to be as effective in promoting anti-smoking message awareness, comprehension and acceptance and twice as effective on intention to act (p = .03) compared with sports events. Conclusion: This study provides evidence of the effectiveness of arts sponsorship to promote health to the general population, that is, health in arts. Promoting an anti-smoking message in arts settings was as, or more, effective than in sports settings. Results suggest that the arts should be utilised to communicate and reinforce anti-smoking messages to the general population. The suitability of the arts to promote other types of health messages should be investigated further.

What are the determinants of food security among regional and remote Western Australian children

Objective: To explore how determinants of food security affect children in regional and remote Western Australia (WA), across food availability, access and utilisation dimensions.

Which Food Security Determinants Predict Adequate Vegetable Consumption among Rural Western Australian Children

Improving the suboptimal vegetable consumption among the majority of Australian children is imperative in reducing chronic disease risk. The objective of this research was to determine whether there was a relationship between food security determinants (FSD) (i.e., food availability, access, and utilisation dimensions) and adequate vegetable consumption among children living in regional and remote Western Australia (WA). Caregiver-child dyads (n = 256) living in non-metropolitan/rural WA completed cross-sectional surveys that included questions on FSD, demographics and usual vegetable intake. A total of 187 dyads were included in analyses, which included descriptive and logistic regression analyses via IBM SPSS (version 23). A total of 13.4% of children in this sample had adequate vegetable intake. FSD that met inclusion criteria (p ≤ 0.20) for multivariable regression analyses included price; promotion; quality; location of food outlets; variety of vegetable types; financial resources; and transport to outlets. After adjustment for potential demographic confounders, the FSD that predicted adequate vegetable consumption were, variety of vegetable types consumed (p = 0.007), promotion (p = 0.017), location of food outlets (p = 0.027), and price (p = 0.043). Food retail outlets should ensure that adequate varieties of vegetable types (i.e., fresh, frozen, tinned) are available, vegetable messages should be promoted through food retail outlets and in community settings, towns should include a range of vegetable purchasing options, increase their reliance on a local food supply and increase transport options to enable affordable vegetable purchasing.

Prevalence and socio‐demographic predictors of food insecurity among regional and remote Western Australian children

Objective: Inequities can negatively impact the health outcomes of children. The aims of this study were to: i) ascertain the prevalence of food insecurity (FI) among regional and remote Western Australian (WA) children; and ii) determine which socio‐demographic factors predicted child FI.

Healthy food intentions fail to lead to healthy consumption at an Australian festival

Aim To investigate healthy food purchasing intentions and behaviours among patrons attending a large festival and any associations with healthy eating attitudes, social norms or perceived behavioural control. Methods Food consumption intention and behaviour were measured via pre (upon entry)-post (prior to exit) surveys among West Australian adults at the Perth Royal Show (n = 100; 66 female and 34 male). Attitude, social norm and perceived control were measured via 5-point Likert scales. McNemar chi-squared tests were conducted on the pre-post measures, an anova was conducted for continuous variables, and a path analysis with bootstrapping was performed to examine the relationships from healthy eating attitudes, social norms and perceived control to intentions and behaviours. Results Upon entry, 71% intended to purchase food; however, significantly more participants (84%, P < 0.05) actually bought food. Of those who intended to buy food, 82% anticipated buying unhealthy food and 44% healthy food. On exiting, significantly more patrons purchased unhealthy foods (97%, P < 0.01) and significantly fewer bought healthy foods (22%, P < 0.01). There were no significant associations between intentions, behaviours, healthy eating attitudes, social norms or perceived control. Conclusions Overall, most patrons intended and actually purchased unhealthy foods. However, among patrons who did not intend to purchase food, or planned to buy healthy food, they too bought mostly unhealthy foods. Additional efforts to promote and provide healthy choices are required.

Culture, management and finances as key aspects for healthy workplace initiatives.

The aim of this study was to qualitatively explore the barriers and enablers to implementing healthy workplace initiatives in a sample of workplaces based in Perth, Western Australia. In-depth interviews were conducted with representatives from 31 organizations representing small, medium and large businesses in the Perth metropolitan area which reported having healthy workplace initiatives. In total, 43 factors were mentioned as influencing the implementation of healthy workplace initiatives. Factors appearing to exert the most influence on the implementation of health promoting initiatives in this sample were culture; support from managers and staff; collaboration with industry providers; financial resources circumstances and the physical environment. These factors appeared to be mutually reinforcing and interconnected. Findings suggest there may be merit in applying an organizational development lens to the implementation of workplace health promotion initiatives as this could assist in leveraging enablers and minimizing barriers.