A Randomized Waitlist-Controlled Trial of an Intergenerational Arts and Heritage-Based Intervention in Singapore: Project ARTISAN

Loneliness has become a global major public health concern, with detrimental effects to the young and old. ARTISAN (Aspiration and Resilience Through Intergenerational Storytelling and Art-based Narratives) is a 5-week, 15-h participatory art and group-based intervention that focuses on resilience building and loneliness alleviation among the young and old through a structured multimodal framework held at a museum space. Developed with a Participatory Action Research (PAR) approach, this intervention is evaluated using an open-label waitlist randomized controlled trial design (RCT) comprised of community-dwelling youth and older adults randomized into an intervention group (n = 35) or a waitlist-control group (n = 33). Participants were assessed on standardized self-reported psychometric measures including loneliness, resilience, quality of life, social support, life satisfaction and national identity at three time points. Qualitative data generated during each intervention session as well as acceptability focus groups were recorded and transcribed. Linear mixed modeling analyses revealed that participants in the intervention group experienced improvements in life satisfaction compared to participants in the waitlist-control group (95% CI: 0.22 to 0.77, p < 0.001, Cohen's d = 0.53) immediately after the completion of ARTISAN. Subgroup analyses for youth participants indicated improvements in quality of life (95% CI: 0.16 to 0.52, p < 0.001, d = 1.31) and national identity (95% CI: 0.18 to 0.80, p = 0.002, d = 0.43) in comparison to the waitlist-control group. At 5-weeks follow-up, the intervention group participants continued to experience high levels of life satisfaction (95% CI: 0.04 to 0.42, p = 0.017, d = 0.47), enhancements in resilience (95% CI: 0.07 to 0.55, p = 0.011, d = 0.46), as well as a significant reduction in loneliness (95% CI: −0.34 to −0.08, p = 0.001, d = 0.61) compared to baseline, reflecting the effectiveness and positive residual effects of the ARTISAN intervention. Similarly, the qualitative findings provided support for the intervention and additional insights to the quantitative findings. This holistic intervention framework that integrates stories, arts and heritage for bridging and empowering lives fills a critical gap in knowledge and practice between the arts, health and citizenship, paving the way for further research in creating a more caring and inclusive society with the arts

A qualitative examination on the implementation of participatory “A”rt-based activity on “Health” of older community-dwellers: what worked for the Singapore A-Health Intervention?

Introduction: Art and museum-based interventions are gaining increasing recognition for their potential as low-risk activities for older adults, offering numerous physical, cognitive, and emotional benefits. However, there remains a dearth of knowledge regarding the science of implementation as well as the factors and processes that contribute to their effectiveness from the perspectives of intervention participants. Methods: The current research draws on the qualitative evaluation data obtained from a larger mixed-method randomized control trial that evaluated a standardized Participatory “A”rt-Based Activity On “Health” of Older Community-Dwellers—the Singapore A-Health Intervention. Adopting a participatory action research approach, the primary objective is to critically examine the lived experiences and health impact of the Singapore A-Health Intervention with a secondary objective to uncover strategies for optimized implementation outcomes. All 56 participants who completed the intervention filled out a program evaluation survey and a nested sample of 30 participants completed a series of acceptability focus groups. Results: Descriptive analyses of the program evaluation survey data revealed that 96.2% of participants were satisfied with the overall experience of the Singapore A-Health intervention (M = 9.00, SD = 1.76), reported that the intervention positively impacted their quality of life (M = 8.90, SD = 1.43), and social wellbeing (M = 8.92, SD = 1.43). Thematic analysis with a grounded theory approach on the qualitative focus group data revealed three interrelated themes detailing how the Singapore A-Health Intervention contributed to positive health and wellbeing outcomes (1. A-Health Experience, 2. Wellbeing Outcomes, 3. Enabling Factors) and nine subthemes (1a. Intellectual Stimulation, 1b. Positive Stress, 1c. Peer Interaction, 2a. Interpersonal Bonds, 2b. Personal Growth, 2c. Mindful Living, 3a. Integrated Support, 3b. Session Design, 3c. Mode of Engagement). Discussion: This investigation provides important insights to the Singapore A-Health intervention’s effectiveness for enhancing wellbeing among older adults, as well as the factors that enable successful program implementation. These findings offer a culturally unique perspective on the benefits of art and museum interventions, while underscoring the imperative need for strong partnership and collaborations among community stakeholders in supporting the health and wellbeing of ageing populations

Effects of participatory ‘A’rt-Based Activity On ‘Health’ of Older Community-Dwellers: results from a randomized control trial of the Singapore A-Health Intervention

Introduction: The practice of participatory art has been found to support the promotion, prevention, and management of health across the lifespan. However, clinical trials investigating the benefits of creative activities curated with and conducted in museums among older adults in East Asia remains limited. Methods: The current research utilized a single-site, open-label randomized control trial (RCT) to evaluate a standardized Participatory ‘A’rt-Based Activity On ‘Health’ of Older Community-Dwellers – the Singapore A-Health Intervention. Outcome measures include frailty as assessed by the Centre of Excellence on Longevity Self-administered Questionnaire, wellbeing as assessed by the Warwick-Edinburgh Mental Wellbeing Scales, and quality of life as assessed by the EuroQol-5D. 112 participants aged 60 and above were randomized into the intervention group (n = 56) or an inactive control group (n = 56). Participants completed four standardized online self-administered assessments at baseline, 5-week, 9-week and 12-week follow-up during the intervention period. Results: Linear mixed model analyses revealed no statistically significant differences between the intervention group and control group for all outcome measures. However, within the intervention group, a consistent significant reduction in frailty was observed across time from baseline to 9 weeks (MD −0.44, 95% CI −0.85 to −0.039, p = 0.032), 5-weeks to 9-weeks (MD −0.64, 95% CI −1.03 to −0.24, p = 0.002), and 5-weeks to 12-weeks (MD −0.51, 95% CI −0.91 to −0.10, p = 0.014). Moreover, the post-test mean wellbeing score in the intervention group significantly improved over time at 9-weeks (MD 1.65, 95% CI 0.09 to 3.22, p = 0.039) and 12-week (MD 2.42, 95% CI 0.67 to 4.16, p = 0.006) as compared to baseline scores. Discussion: The findings demonstrate the potential of a structured art and museum-based intervention as a resource for promoting health among aging populations. Such benefits transcend social, cultural, and societal contexts. Clinical trial registration: ClinicalTrial.gov, NCT05945589

Slow art plus: developing and piloting a single session art gallery-based intervention for mental health promotion via a mixed method waitlist randomized control trial

IntroductionThe current study builds on the expertise of National Gallery Singapore and Nanyang Technological University Singapore (NTU) in developing and piloting an enhanced version of the Slow Art program, namely “Slow Art Plus” for mental health promotion.MethodsA single-site, open-label, waitlist Randomized Control Trial (RCT) design comprising of a treatment group and waitlist control group was adopted (ClinicalTrials.gov ID: NCT05803226). Participants (N = 196) completed three online questionnaires at three timepoints: baseline [T1], immediately post-intervention/s baseline [T2], post-intervention follow-up/immediately post-intervention [T3]. Qualitative focus groups were conducted to evaluate program acceptability.ResultsA mixed model ANOVA was performed to understand intervention effectiveness between the immediate intervention group and waitlist control group. The analyses revealed a significant interaction effect where intervention group participants reported an improvement in spiritual well-being (p = 0.001), describing their thoughts and experiences (p = 0.02), and nonreacting to inner experiences (p = 0.01) immediately after Slow Art Plus as compared to the control group. Additionally, one-way repeated measure ANOVAs were conducted for the intervention group to evaluate maintenance effects of the intervention. The analyses indicated significant improvements in perceived stress (p < 0.001), mindfulness (p < 0.001) as well as multiple mindfulness subscales, active engagement with the world (p = 0.003), and self-compassion (p = 0.02) 1 day after the completion of Slow Art Plus. Results from framework analysis of focus group data revealed a total of two themes (1: Experiences of Slow Art Plus, 2: Insights to Effective Implementation) and six subthemes (1a: Peaceful relaxation, 1b: Self-Compassion, 1c: Widened Perspective, 2a: Valuable Components, 2b: Execution Requisites, 2c: Suggested Enhancements), providing valuable insights to the overall experience and implementation of the intervention.DiscussionSlow Art Plus represents a unique approach, offering a standardized, multimodal, single-session program that integrates mindfulness and self-compassion practices, as well as reflective and creative expressions with Southeast Asian art. It demonstrates potential in meeting the mental health needs of a wide range of individuals and could be readily incorporated into social prescribing initiatives for diverse populations

Familism and depression among Singaporeans with coronary heart disease: The mediating role of social support and self-perceived burden

Cardiovascular diseases (CVD) are the leading cause of mortality in Singapore, and Coronary Heart Disease (CHD) is the highest contributor to CVD figures. Mood disorders such as depression are prevalent amongst patients with CHD. Past research has focused on the individual risk factors predicting depression, but there is a dearth of research examining how familial attitudes may predict depression. Patients with CHD would be required to make various adjustments in life, and these changes would usually involve the family of the patient. The attitudes that the patient has toward their family members may play a role in their management of CHD. This study was conducted to explore the influence of attitudinal familism on depression in CHD patients, and investigate the potential mediation pathways. Self-perceived burden and social support were the two proposed mediators. Self-report questionnaires on familism, depressive symptoms, social support and self-perceived burden were administered to 86 participants undergoing cardiac rehabilitation at the Singapore Heart Foundation. Hierarchical multiple regression analyses were conducted to test the hypotheses. The findings revealed that familism was not predictive of depressive symptoms, self-perceived burden and social support. In addition, social support and self-perceived burden were found to be significant predictors of depressive symptoms. Further analyses suggested a moderating effect of social support between self-perceived burden and depression. Healthcare professionals should consider assessing patients with CHD for feelings of self-perceived burden and social support to identify patients who may require clinical attention.Bachelor of Art

Creative ageing in Singapore : a population study on participatory arts engagement and wellbeing among adults aged 50 and above

While anecdotal and increasing empirical evidence suggest that participatory arts can play an essential role in supporting a healthy ageing population, much less research has been conducted in Asian societies. Furthermore, despite growing interest in arts programmes for older adults in Singapore, little is known about the patterns and impact of arts engagement among local seniors. This thesis presents an analysis of the quantitative data of a larger mixed-methods population research, namely, the ‘Arts for Ageing Well’ study to understand the patterns of arts engagement among Singaporean adults aged 50 and above, to investigate the relationships between participatory arts engagement and holistic wellbeing, as well as to explore the impact that specific art form engagements may have on health and wellness. Adopting a cross-sectional stratified random household survey, 1,067 community-dwelling Singaporean older adults between the ages of 50-95 years were recruited from all residential areas across Singapore. Participants were administered a self-reported questionnaire which evaluated a comprehensive list of active and passive participatory arts engagement. Outcome measures included quality of life, self-rated health, spiritual wellbeing and social support. Control variables included demographic information, self-reported health status, intensity and frequency of physical exercises. Descriptive analyses indicated that passive arts engagement rate was 60% while active arts engagement rate was 17% among older adults aged 50 and above. Respondents expressed that their greatest interest lies within the genre of culture and heritage arts, with a strong preference to engage in arts activities within the community, and to attend such activities with their family or friends. Findings from propensity score matching with t-test analyses revealed that respondents who passively engaged in the arts experienced better quality of life t(728) = 3.35, p = .0008, d = .25, self-perceived health t(728) = 2.21, p = .028, d = 0.16, and sense of belonging t(728) = 2.17, p = .028, d = 0.16, as compared to those who did not. Moreover, participants who actively engaged in the arts experienced enhanced quality of life t(442)= 3.68, p = .0003, d = 0.36, self-perceived health t(442) =2.59, p = .0099, d = 0.25 and spiritual wellbeing t(442) = 3.75, p = .0002, d = 0.37, as compared to non-art active participants. Exploratory t-tests conducted for engagement in specific art form revealed that both passive and active engagements in dance was most beneficial for the wellbeing of the older adults in the study. This research highlights the potential health benefits of arts engagement among community dwelling older adults and provided robust evidence for Asian societies to invest in the arts for health promotion and research. Practice and policy recommendations are discussed.Master of Art

Arts for ageing well : a propensity score matching analysis of the effects of arts engagements on holistic well-being among older Asian adults above 50 years of age

Objective: To assess the frequency and intensity of arts engagement inclusive of active and passive engagements in arts, culture and heritage activities among Singaporean adults aged 50 and above, and examine the relationships between participatory art and holistic well-being. Design: Cross-sectional stratified household survey. Setting: All residential areas across Singapore’s Central, East, North, North-East and West Regions. Participants: 1067 community-dwelling, Singaporean older adults between the ages of 50 and 95 years were recruited. Primary and secondary outcome measures: Respondents completed a self-reported questionnaire, consisting of standardised ad hoc items assessing the frequencies and durations of active and passive participatory arts engagement, as well as validated psychometric assessments on psychosociospiritual health including the primary outcome measure on quality of life, and the secondary outcome measures on physical, psychological, emotional, spiritual, and social well-being. sociodemographic information, as well as frequency and intensity of physical activity were also collected. Results: Passive engagement (60%) and active engagement (17%) in the arts were associated with better holistic wellness and social support. Specifically, findings from the propensity score matching and independent t-test analyses revealed that adults aged 50 and above who passively engaged in arts and culture-related events experienced higher quality of life (t(728)=3.35, p=0.0008, d=0.25), perceived health (t(728)=2.21, p=0.0277, d=0.16) and sense of belonging (t(728)=2.17, p=0.03, d=0.16), as compared with those who did not. Moreover, those who actively engaged in participatory arts experienced greater quality of life (t(442)=3.68, p=0.0003, d=0.36), self-rated health (t(442)=2.59, p=0.0099, d=0.25), spiritual well-being (t(442)=3.75, p=0.0002, d=0.37), meaning in life (t(442)=5.03, p<0.0001, d=0.50) and sense of peace (t(442)=3.72, p=0.0002, d=0.36), as compared with those who did not actively engaged in the arts. Conclusion: This study provided robust evidence to support a significant causal relationship between arts engagements and holistic well-being. Recommendations for art-based public health and elderly care research, practice and policy are discussed.Published versio

Effects of participatory ‘A’rt-Based Activity On ‘Health’ of Older Community-Dwellers: results from a randomized control trial of the Singapore A-Health Intervention

Introduction: The practice of participatory art has been found to support the promotion, prevention, and management of health across the lifespan. However, clinical trials investigating the benefits of creative activities curated with and conducted in museums among older adults in East Asia remains limited. Methods: The current research utilized a single-site, open-label randomized control trial (RCT) to evaluate a standardized Participatory ‘A’rt-Based Activity On ‘Health’ of Older Community-Dwellers – the Singapore A-Health Intervention. Outcome measures include frailty as assessed by the Centre of Excellence on Longevity Self-administered Questionnaire, wellbeing as assessed by the Warwick-Edinburgh Mental Wellbeing Scales, and quality of life as assessed by the EuroQol-5D. 112 participants aged 60 and above were randomized into the intervention group (n = 56) or an inactive control group (n = 56). Participants completed four standardized online self-administered assessments at baseline, 5-week, 9-week and 12-week follow-up during the intervention period. Results: Linear mixed model analyses revealed no statistically significant differences between the intervention group and control group for all outcome measures. However, within the intervention group, a consistent significant reduction in frailty was observed across time from baseline to 9 weeks (MD −0.44, 95% CI −0.85 to −0.039, p = 0.032), 5-weeks to 9-weeks (MD −0.64, 95% CI −1.03 to −0.24, p = 0.002), and 5-weeks to 12-weeks (MD −0.51, 95% CI −0.91 to −0.10, p = 0.014). Moreover, the post-test mean wellbeing score in the intervention group significantly improved over time at 9-weeks (MD 1.65, 95% CI 0.09 to 3.22, p = 0.039) and 12-week (MD 2.42, 95% CI 0.67 to 4.16, p = 0.006) as compared to baseline scores. Discussion: The findings demonstrate the potential of a structured art and museum-based intervention as a resource for promoting health among aging populations. Such benefits transcend social, cultural, and societal contexts. Clinical trial registration: ClinicalTrial.gov, NCT05945589