Understanding well-being outcomes in primary care arts on referral interventions: a mixed method study

Background: Arts on Prescription programmes are designed to support mental health and well-being of patients with a variety of clinical needs within the community. Despite a number of studies reporting benefits, there are some patients that do not see improvements in well-being. Yet, there is limited research investigating the reasons for this. Methods: Using a sequential mixed-methods design the present study sought to understand why some participants (N=312) experienced an increase in well-being and others did not (N=95) after attending an Arts on Prescription intervention based in the South West of England between 2009 and 2016. Results: Quantitative comparisons between the two groups identified little differences, aside from age and baseline well-being (WEMWBS scores), with those that improved being slightly younger, and having lower well-being at the outset compared with those that did not improve. A process model depicting the perceived facilitative and inhibitive factors of attending the programme was developed from the qualitative findings. This model suggests that the social aspect of the course may be implicated in the participants differential outcomes; with those that showed a decrease in well-being reporting difficulties in interacting with others during the intervention. Further, the participants who reported an increase in well-being felt vulnerable to “relapse” when finishing the course due to uncertainties regarding future support and at their ability to maintain their well-being without the provision of the programme. Conclusions: This research suggests a need to promote communication amongst groups in such interventions with the hope that this will provide a more facilitative environment for all participants to benefit. Also, such programmes should consider follow-on options to ensure the participants feel supported and confident in managing their well-being once the course comes to an end. Findings will be pertinent to those commissioning primary care art interventions, ensuring that referral policies and pathways are designed for optimal effectiveness and for potentially tailoring social prescribing programmes to suit the participants specific needs.