Interaction ritual chains at the Fringe

‘Measuring’ or ‘capturing’ cultural value is a key endeavour for those who seek to justify the provision of public investment in arts and cultural activities. This approach is commonly manifested in the literature exploring the ‘impact’ of arts festivals, emphasising their transactional ‘benefit’ to individuals and host cities. In this thesis, I explore an alternative approach to value, analysing it as a meaning-making process in the context of the world’s largest arts festival: the Edinburgh Festival Fringe. Using Randall Collins’ (2004) theory of Interaction Ritual Chains (IRCs) as a theoretical framework, I examine data collected through ethnographic observations, researcher reflections, documentary analysis, and two-stage focus groups with 18 small groups (production companies and community groups). Grounded in this fieldwork, the study argues that groups are able to derive meaning from Fringe experiences when they align with a shared morality, such as believing in the intrinsic value of art objects and the importance of preserving the Fringe as an ‘open access’ festival. For groups who share this morality, the Fringe acts as a ‘sacred site’ at which to annually ‘perform’ and reaffirm shared beliefs in a public setting, and where meaning is cultivated before and continues after the period of attendance. Further, an emotional contagion effect for ‘believers’ within and across groups is created through successful IRCs, which buttresses and maintains the sacred status of the Fringe. The thesis concludes that the cultural policy focus on ‘capturing’ cultural value is fruitless because there is no ‘objective’ cultural value. Rather, meaning-making is an on-going and interactive process that extends outwards from art objects and is connected to shared emotions, morality, and beliefs. The major implication of this research for arts organisations and policymakers is that this new way of approaching value can be used to explain why one-off transactional encounters with art objects have only short-term effects. The thesis recommends a shift in focus from individual transactions to group processes, and from short-term funding models to ones that have the potential to facilitate deeper engagement with meaning-making across time and contexts

Online 'chats': fostering communitas and psychosocial support for people working across arts and play for health and wellbeing

Loss of work, furlough, and increased social isolation were prevalent for many working in the broad context of cultural and community engagement for health and wellbeing. This study set out to explore if and how regular online group interactions may foster social cohesion and provide support for these individuals during the critical time of the COVID-19 global pandemic. It was conducted in the context of the 'social cohesion chat' series led by a network called the Arts Play Health Community which was initiated in response to the pandemic as a way to bring those working in or connected to arts, play and health together during times of social isolation. Two qualitative focus groups with creative, participatory components were conducted with artists, researchers, evaluators, and arts/play managers (n = 11), and then analyzed using thematic analysis. Researcher ethnographic reflections and fieldnotes were also collected and analyzed. The authors engaged in reflexive online discussions to integrate and synthesize findings across different data. Four themes were constructed through the analysis procedure: (1) 'Building an online community as processes of communitas', spotlighting the importance of the non-hierarchical structure of the 'chats' particularly in relation to there being 'no end goal' to the online dialogues; (2) 'Individual and shared emotional experiences' that underpinned feelings of connection to others and the online space; (3) 'Psychosocial benefits' such as improving confidence and providing an opportunity to 'have a voice' in the community; and (4) 'The importance of facilitation', highlighting the opportunities the chats provided for participants to feel validated and valued as an active member of the community. The article concludes that constructing an inclusive and welcoming online community, where active participation is at the heart of regular social interactions can provide support for those working across arts and play for health and wellbeing. This was particularly important during the societal turbulence of the COVID-19 pandemic. It further concludes by noting the unique structure of these online dialogues as not being connected to institutions, with this playing a key role in allowing those in the community to 'be themselves' within it

How does the process of group singing impact on people affected by cancer? A grounded theory study

OBJECTIVE: This study aimed to build an understanding of how the process of singing impacts on those who are affected by cancer, including patients, staff, carers and those who have been bereaved. DESIGN: A qualitative study, informed by a grounded theory approach. SETTING AND PARTICIPANTS: Patients with cancer, staff, carers and bereaved who had participated for a minimum of 6 weeks in one of two choirs for people affected by cancer. METHODS: 31 participants took part in Focus Group Interviews lasting between 45 min and an hour, and 1 participant had a face-to-face interview. FINDINGS: Four overarching themes emerged from the iterative analysis procedure. The overarching themes were: building resilience, social support, psychological dimensions and process issues. Following further analyses, a theoretical model was created to depict how building resilience underpins the findings. CONCLUSION: Group singing may be a suitable intervention for building resilience in those affected by cancer via an interaction between the experience and impact of the choir

What are the active ingredients of ‘arts in health’ activities? Development of the INgredients iN ArTs in hEalth (INNATE) framework

Background: There is a scarcity of research concerning what it is about arts engagement that may activate causal mechanisms leading to effects on health and wellbeing: their active ingredients. Further, the limited studies that do exist have tended to be relevant to specific contexts and types of art forms. The aim of this study was to carry out a comprehensive mapping of potential active ingredients, construct a shared language, and propose a framework and toolkit to support the design, implementation, and evaluation of arts in health activities. Methods: Drawing upon Rapid Appraisal techniques and collaborating with 64 participants working in arts in health, we engaged in a three-phase process: 1) scoping review to inform the development of an initial framework; 2) consultation on the initial framework; and 3) analysis and construction of the INNATE framework. Results: The study identified 139 potential active ingredients within the overarching categories of  project, people, and  contexts.  Project components relate directly to the content of the arts activity itself, intrinsic to what the activity is. The  people category denotes how people interact through engagement with the activity and who is involved in this interaction, including activity facilitation.  Contexts relates to the activity setting comprising the aggregate of place(s), things, and surroundings. Aligning with complexity science, ingredients may interconnect or feed into one another to prompt mechanisms, and may not be experienced as distinct by participants. Conclusions: Our mapping exercise is the most extensive to date. In relation to arts in health activities, the INNATE framework can support with: design and implementation, such as co-producing an intervention to meet the needs of a particular population; evaluation, such as facilitating the comparison of different interventions and their efficacy; and replication, scalability, and sustainability through enabling detailed reporting and articulation of what an arts in health activity entails

Group singing in bereavement:Effects on mental health, self-efficacy, self-esteem and well-being

OBJECTIVES: Bereavement is associated with negative affective, cognitive, behavioural and physiological responses. However, factors, such as coping, self-efficacy and self-esteem, can buffer negative effects of grief, and can be increased through mutual support interventions, such as shared leisure activities. This study used a non-randomised controlled design to explore the effects of group choir singing on mental health among people who have been bereaved due to cancer. METHODS: A total of 58 adults bereaved in the last 5 years who had not started psychological therapy in the last 12 weeks or medication for anxiety or depression in the last month were recruited and elected to join a choir (n=29) or participate in the non-intervention control group (n=29). Joining a choir involved engaging in 90 min weekly singing and social sessions for 12 weeks with a post-intervention assessment at week 24. We used linear mixed effects models adjusted for demographics, health-related variables, musical engagement and time since bereavement to model changes over time between the two groups in symptoms of anxiety, depression, well-being, self-efficacy and self-esteem. RESULTS: Participants who sang in a choir had more stable symptoms of depression and levels of well-being, as well as gradual improvements in their sense of self-efficacy and self-esteem over the 24 weeks. In contrast, those in the control group showed gradual increases in depressive symptoms, reductions in levels of well-being and self-esteem and no improvement in their self-efficacy. These results were independent of all covariates. CONCLUSIONS: Weekly group singing could be a promising mutual support intervention for people experiencing grief. TRIAL REGISTRATION NUMBER: NCT02756780

Psychosocial singing interventions for the mental health and well-being of family carers of patients with cancer:Results from a longitudinal controlled study

OBJECTIVE: The mental health challenges facing people who care for somebody with cancer are well documented. While many support interventions focus on provision of information or cognitive behavioural therapy, the literature suggests that psychosocial interventions could also be of value, especially given the low social support frequently reported by carers. Singing is a psychosocial activity shown to improve social support, increase positive emotions, and reduce fatigue and stress. This study explored whether weekly group singing can reduce anxiety, depression and well-being in cancer carers over a 6-month period. DESIGN: A multisite non-randomised longitudinal controlled study. SETTING: The Royal Marsden National Health Service Trust in Greater London. PARTICIPANTS: 62 adults who currently care for a spouse, relative or close friend with cancer who had not recently started any psychological therapy or medication. INTERVENTIONS: On enrolment, participants selected to join a weekly community choir for 12 weeks (n=33) or continue with life as usual (n=29). OUTCOME MEASURES: The primary outcome was mental health using the Hospital Anxiety and Depression Scale. The secondary outcome was well-being using the Warwick Edinburgh Mental Wellbeing Scale. Using linear mixed effects models, we compared the change in mental health and well-being over time between the two groups while adjusting for confounding variables including demographics, health-related variables, musical engagement and length of time caring. RESULTS: Participants in the choir group showed a significantly greater decrease in anxiety over time than participants in the control group (B=-0.94, SE=0.38, p=0.013) and a significantly greater increase in well-being (B=1.25, SE=0.49, p=0.011). No changes were found for depression. Sub-group analyses showed carers with anxiety or below-average well-being were most likely to benefit. CONCLUSIONS: This study builds on previous research showing the mental health benefits of singing for people with cancer by showing that weekly singing can also support anxiety and well-being in cancer carers

Understanding changes to perceived socioeconomic and psychosocial adversities during COVID-19 for UK freelance cultural workers

There is a dearth of qualitative research exploring how freelancers working in the cultural industries have been affected during COVID-19. In particular, there is a lack of research exploring how socioeconomic and psychosocial adversities may have changed or evolved, and how these changes have been perceived and subjectively experienced by freelance cultural workers. This study builds on qualitative interviews carried out in July–November 2020 (n = 20) by exploring findings from follow-up interviews conducted in May–July 2021 (n = 16). It presents an inequality of experiences connected to a range of socioeconomic and psychosocial factors, showing how some freelancers experienced small changes (e.g. to the kind of work carried out), with others experiencing major changes (e.g. leaving the sector completely). It concludes with a call for highly bespoke financial and psychological support, as well as a need to rethink what cultural value is for this workforce in the “new normal”, considering changing valuing processes

Making space to learn about teaching:Expanding teaching horizons through postgraduate education

Clinicians develop as teachers via many activities, from on-the-job training to formal academic programmes. Yet, understanding how clinicians develop the sensibilities of an educator and an appreciation of the complexity of educational environments is challenging. Studies of teacher development have maintained a relatively narrow definition of educational practice. A more expansive view encompasses clinical teachers’ roles in relation to elements beyond learners or content, such as the cultures and other structures of healthcare institutions. In our online Postgraduate Certificate in Clinical Education, space and structure are intentionally created for teachers to think and talk about education with colleagues in other disciplinary contexts. We interviewed 17 students about how their approaches to teaching had changed over a year of part-time study, using their teaching philosophies, written at the start of the programme, as points of contrast. We took an abductive approach to data analysis, drawing on the literature and, unavoidably, our own reflexive interpretations of our practice outside of the research context, such as conversations with students and colleagues; our experiences of teaching and our concurrent research and scholarship. Our themes of repertoire building, perspective shifting, embodied practice, and appreciation of context, describe the increasing complexity of individuals’ considerations of teaching. We use our analysis as the basis for a discussion of the blurring of boundaries between staff and students on such programmes as both groups are engaged in an ongoing continuum of development as all teachers, continue to be learners of educational practice. These insights can inform the ways in which postgraduate programmes can make space for clinical teachers to share and reflect on practices, perspectives and contexts