A Postgraduate Course on the Promotion of Health and Well-Being through Creative Methods within the Framework of the ARTHEWE Erasmus+ Project ()
1. Introduction
The World Health Organization (WHO) defines health promotion as the process of enabling individuals and communities to increase control over factors affecting health so as to improve it. Accordingly, the WHO defines health as the state of complete physical, mental, and social well-being and not only as the absence of disease or infirmity, giving social and cultural status to it (WHO, 1948; WHO, 1986). Health as a multidimensional state exists in our daily lives, in environments where we interact, learn, work, entertain, and feel (WHO, 1986). It exists in these same environments that art is created, contributing to the promotion of health, well-being, and social change (Corbin et al., 2021).
To date, several studies have demonstrated the beneficial impact that creative methods and arts have on health, significantly highlighting the need to include them in contemporary policies and the strategic planning of health interventions (Cameron, Crane, Ings, & Taylor, 2013: pp. 52-59; Fancourt, 2017; Corbin et al., 2021; Clift, 2020: pp. 77-83). The scientific literature also demonstrates how important the contribution of creative methods and the arts is to promote the health of individuals and communities, especially when developed in a participatory manner (Corbin et al., 2021). Thus, accessibility is ensured, and social inequalities are reduced (Frishkopf et al., 2016: pp. 22-36; McDonald, Antunez, & Gottemoeller, 2007: pp. 265-278). Depending on their object, creative activities can include social interaction, physical activity, entertainment, etc. (Clift, 2020: pp. 77-83). They may include, among others, engagement of the senses and imagination, sensory activation, elicitation of emotion, and cognitive stimulation (Gorny-Wegrzyn & Perry, 2022: pp. 290-303).
Engaging in the arts and creative activities is related to good general physical and mental health as well as quality of life. Individuals who are creatively active have high self-esteem, subjective well-being, and overall life satisfaction (Michalos, 2005: pp. 11-59; Howlin, 2022: pp. 410-422). For example, engaging in photography activities is associated with a high sense of well-being and meaning in life (Tourigny & Naydenova, 2020; Breckon & Lake, 2022: pp. 114-119). During the recent COVID-19 pandemic, photography-based interventions positively impacted the mental health of participants, demonstrating reduced levels of anxiety, high levels of satisfaction, and feelings of optimism (Read, Mason, & Jones, 2022: pp. 275-291). Accordingly, creative engagement in painting activities is associated with better levels of health and high self-esteem (Bloem, Pfeiffer, & Krack, 2018). Recently, many workplace interventions aimed at promoting the mental health of employees use painting as a means of approach and expression (Karpavičiūtė & Macijauskienė, 2016; Hsu et al., 2021: pp. 217-222). In addition, creative approaches can help encourage health-promoting behaviors such as healthy eating and reducing or even quitting smoking, leading to a lower risk of mortality from cardiovascular and neoplastic diseases (Wang et al., 2014). Studies have shown that listening to music, for example, enhances motivation for regular exercise. Music makes exercise fun, increases satisfaction, and maximizes health benefits (Clark, Baker, & Taylor, 2016: pp. 76-104; Chair, Zou, & Cao, 2021). In emergency situations, artistic interventions, including music, crafts, and drama can be found to reduce stress and pain in children and blood pressure in their parents (Solowiejczyk, Villanueva, & Mackenna, 2018: p. 230).
The arts and creative methods can also have a positive impact on a wide range of needs in therapeutic and rehabilitative settings, from prevention to disease management, making a significant contribution to ensuring and improving health and quality of life (Clift, 2011: p. 8; De Vecchi, Kenny, & Kidd, 2015; Oren et al., 2019: pp. 41-47). Particular benefits from the implementation of creative programs and interventions are observed in long-term care settings for vulnerable people (Curtis et al., 2018: pp. 645-669). Music, for example, has been found to reduce the side effects of cancer treatment, such as drowsiness, lack of appetite, shortness of breath, and nausea (Stanczyk, 2011: pp. 170-172). It may also support cognitive function in people with dementia (Soufineyestani, Kahn, & Sufineyestani, 2021: pp. 1-17). Μusic therapy promotes emotional skills in adolescents with mental health conditions (Salokivi et al., 2023: pp. 423-444). Singing, in particular, has been found to improve attention, episodic memory, and executive function (Higuti et al., 2021: pp. 292-296). Dance has repeatedly been found to provide clinically significant improvement in movement problems in people with Parkinson’s disease (Pereira et al., 2019: pp. 49-56; Clift, 2020: pp. 77-83). Painting is a widespread psychotherapeutic tool, with the application either in a mental assessment test or in psychosocial rehabilitation, enhancing the recovery process (Caddy, Crawford, & Page, 2012: pp. 327-333; Van Lith, 2014: pp. 19-36; Lengen, 2015: pp. 166-177).
Many of the creative approaches (e.g., music, painting, photography, etc.) provide the possibility of non-linguistic ways of presenting knowledge and information, overcoming the barriers of illiteracy (Clift, 2020: pp. 77-83; Corbin et al., 2021). Since creative interventions can be easily adapted to respond to people from different cultural backgrounds, they can also strengthen commitment to the participation of minority groups or groups that are difficult to reach through traditional interventions (Clift, 2020: pp. 77-83). Thus, an arts-based health promotion program can be an important bridge to eliminate health inequalities and share knowledge about it (Corbin et al., 2021). For example, participation in non-traditional activities such as crafts and singing is particularly effective in promoting cooperation, self-concept, and a sense of social inclusion for culturally diverse children, adults, families, and communities (Bang, 2016: pp. 355-376; Welch et al., 2014; Boer & Abubakar, 2014).
Hence, there has been an effort by Higher Education Institutions and especially study programmes in the field of health sciences, to integrate the arts into their curricula and to adopt creative methods as tools of educational interventions (Robinson, 2007: pp. 173-180; Perry, Maffulli, Willson, & Morrissey, 2011: pp. 141-148; Hongtao, 2021: pp. 36-42).
The purpose of this article is to present a postgraduate course on promoting health and well-being through creative methods, which was developed and piloted during the ARTHEWE Erasmus+ project. The ultimate goal was to develop a course aiming to familiarize students with creative methods and to understand the relationship of arts and creative methods to the promotion of health and well-being.
2. Methodology
“ARTHEWE—Multiform Pedagogy in Arts, Health and Well-Being Education” Erasmus+ funded project (2020-1-FI01-KA203-066652) develops multiform pedagogical approaches and art-based methods in the field of arts and health as part of online and contact learning, as well as interprofessional work in the field of arts and health. In the ARTHEWE three-year project (https://arthewe.turkuamk.fi/), five European Higher Education Institutions (Turku University of Applied Sciences, Finland—Project Lead; Royal College of Music in Stockholm, Sweden; University of West Attica, Greece; King’s College London, UK; Trinity College Dublin—Global Brain Health Institute, Ireland) are developing higher education related to the field of arts and health. In each partner organization, the project has co-developed, among the partners, study modules related to either social and health sector, well-being and health promotion, arts and culture curricula, or other study modules.
The contents of the study modules developed in the ARTHEWE project include, among other things, promotion of well-being and health through creative methods; sustainability and personal professional growth; meta-skills needed in working life; arts-based and embodied methods. These modules are grounded in a multiform pedagogical framework that integrates art-based methods in the field of arts and health, applied in both online and in-person learning, as well as interprofessional collaboration within the arts and health. (ARTHEWE, 2023). In the ARTHEWE project, the consortium collaborated on seven intellectual outputs, as can be seen in Table 1.
Table 1. Intellectual outputs of ARTHEWE Erasmus+ project.
Intellectual Output (IO) |
Description |
IO1—Publication Towards Creative Well-Being—Codeveloping Multimodal Pedagogical Approaches in Higher Education |
A publication that gathered together a rich variety of pedagogical approaches explored and co-developed by the ARTHEWE team members and students. It consisted of seven articles regarding the historical and musicological perspectives on arts in relation to health, aesthetics, and creativity, pedagogies for flourishing in uncertainty and complexity, the process of professional growth in creative well-being, etc. |
IO2—Professional Growth in Creative Well-Being. Expertise growth and growing in professional identity |
Focused on developing the contents and curriculum of the MA programme Creative
Well-Being in international collaboration, developed three MA programme course modules: 1. Creative Well-Being as a Competence; 2. Contexts of Creative Well-Being;
3. The Process of Professional Growth as a Professional of Creative Well-Being. |
IO3—Sustainable and Healthy Working Life—Engaging through Music and Other Creative Activities |
The aim was to build a sustainable health platform, “Health & Arts & Sustainability” (HeArtS), for students, teachers, and researchers. The following steps have been used to build the platform based on focus groups and deep interviews with students. |
IO4—Supporting Mental Health with the Arts: A ten Step Programme |
Arts and health were clearly interwoven as a red thread by a “learning by doing” 10-step program concept building. The program supported students coping with stress and anxiety. The role of discomfort was discussed during the 10-step program building and described as an enabler of change-making and space-making for health as well as for creativity. |
IO5—Health and Well-Being Promotion through Creative Methods Coordinator |
The aim was to add creative strategies and approaches for health and well-being promotion for different target groups in the population. During the project, a course module, Health and Well-Being Promotion through Creative Methods, was co-developed and piloted with the partners. |
IO6—Arts and Well-Being for Personal and Professional Growth |
This Intellectual Output addressed the need to support the well-being of the fellows through the application of arts-based approaches. The project team looked into how to use creativity to support relationship development and also to develop well-being skills—gain emotional awareness, increase body awareness, and learn skills to take better care of yourself. |
IO7—Pedagogies for flourishing in complexity |
This pilot focused on somatic practices, expression, and experiential learning. The aim was to equip students to operate well professionally and personally and to support sustainable practice. The content was designed to build self-awareness, leadership, conflict resolution, situational awareness, and critical and creative thought. |
In the context of this European project, within Intellectual Output 5, a postgraduate course entitled “Health and Well-Being Promotion through Creative Methods” of 2 ECTS was co-developed within the framework of the ARTHEWE Erasmus+ project and led by the Department of Public and Community Health of the University of West Attica (Athens, Greece). The purpose of this postgraduate course was to engage the students in learning activities, with the aim of learning creative strategies for health and wellbeing promotion for different target groups in the population and also how these strategies can be implemented within different health and well-being promotion interventions at the individual and community level.
The learning outcomes of the course included that at the completion of the course, students will:
- know the concepts of health and well-being promotion and how they may be defined in different contexts
- be aware of the participatory approach and co-production in health and well-being promotion
- develop their critical thinking and creativity
- know several creative methods that can be used in health and well-being promotion interventions
- be able to use creative methods and integrate them into health and well-being promotion interventions
- be able to work effectively in teams
The course took place during the autumn semester of the 2021-22 academic year, within one of the postgraduate programmes of the Department of Public and Community Health of the University of West Attica (Greece, Athens). Due to the protection restrictions against COVID-19, the course was held online at that time.
There was a variety of learning activities during the course facilitated by the ARTHEWE partners, including not only lectures but also more active participation focusing on the interaction active and creative involvement of the students such as, group work, creative workshops, for example, developing a poem, an artwork, etc. (see Figure 1 & Figure 2), students’ presentations.
The course was evaluated by the participating students through online questionnaires at two-time points (before and after the end of the course). The questionnaires included three open-ended questions in order to explore the perceptions regarding health and health promotion, as well as participants’ views on creative methods and the meaning of creativity (What does health mean? What does health promotion mean? What do you think of when you hear creative methods and creativity?). The questionnaires also included closed-end questions about the evaluation of the course, obtaining information on the degree of satisfaction, level of difficulty, etc.
Figure 1. Students’ artworks.
Figure 2. Poetry activity.
The study was approved by the Ethics Committee of the University of West Attica (103023-18/11/2021), and informed consent was obtained from all participants. Before the completion of the questionnaire, the 37 students who took part in the current course were informed in detail about the study and its objectives. They were also informed that their participation was anonymous and voluntary and that they had the right to withdraw from the research at any time without any consequences on their studies. Finally, 36 students agreed to participate and fill in the questionnaires.
The average age of the participants was 36 years. More participants’ characteristics (e.g., gender, educational background) are described in Table 2.
Table 2. Participants’ characteristics (N = 36).
Gender |
Educational background |
Female |
27 |
Environmental studies |
Health sciences studies |
Pedagogical studies |
Male |
9 |
4 |
17 |
15 |
The data collected with the open-ended questions was analyzed using content analysis methods, while statistical analysis using descriptive statistics was applied to the data collected via the closed-ended questions.
3. Results
The participants’ perceptions of health, health promotion, and creativity/creative methods are presented below. Furthermore, their evaluation of the course is also discussed.
3.1. Perceptions of Health
The students present a common response, both before and after the implementation of the course, identifying health with the body, life and well-being. For example, to the question “What does health mean?”, participants replied:
“Health is the normal functioning of the human body”
“Health for me is the cornerstone of life”
“Health is well-being”
However, after the end of the course, there is also a perspective toward a more comprehensive conceptualization of health, approaching health not only as the absence of disease or disability but as a holistic dimension of physical, mental and social well-being. For example, participants wrote:
“Health is complete physical, mental, and social well-being”
“Health is a holistic dimension. Physical and mental except disability and disease”
3.2. Perceptions Health Promotion
Regarding the concept of health promotion, the participating students present a common belief before and after completing the course. It is primarily about prevention and a process of developing control to improve health. As participants wrote:
“Prevention aimed at achieving a quality life”
“Health promotion is the process by which you can take control of your health and improve it”
After the end of the course, emphasis is placed on the facilitation and guidance towards promoting health. They described the promotion of health as a way of ensuring and improving health in physical and mental aspects, on an individual level but also on a community level. Participants wrote, for example:
“Τhe assistance and guidance of health-related matters to a population”
“The transfer and teaching, not only of knowledge, but also of good practices that we know throughout society”
“Continuous information to ensure physical and mental health and well-being”
3.3. Perceptions of Creativity and Creative Methods
Regarding the creative methods and creativity, while initially, the students associate these concepts mainly with expression, participation, and creation, resulting in enjoyment and skills development, after the implementation of the postgraduate course, students, in addition to their early perceptions, relate creativity with health promotion. Students, after the current course, refer to creativity as tools, innovative and creative methods of health promotion, alternative activities, interventions and education approaches. As they wrote, for example:
“All those tools and non-traditional interventions used for treatment and education”
“Creative methods are methods that help us promote health. Through theater, cinema, photography, dance, song, literature”
3.4. Students’ Evaluation of the Course
Regarding the evaluation of the course and the degree of satisfaction, answering the corresponding question, all students (n = 36) reported that the course objectives were “very clear” or “clear”. In addition, all students (n = 36) considered that the learning activities were “very responsive” or “responsive” to the objectives of the course. An important feeling that most (n = 25, 69.4%) students who attended the course had was that it did not require prior knowledge. Regarding its level of difficulty, most (n = 25, 69.4%) rated it as “moderate” or “difficult”. Moreover, most of the students (n = 28, 77.8%) rated their satisfaction as “very highly” or “highly” regarding the duration of the course.
Finally, regarding the students’ preference for the course content, the majority of them expressed great satisfaction with the creative activities (e.g., art workshop), the interaction with foreign teachers, and the overall interactive nature of the course.
4. Discussion
Although literature supports the positive effects of the arts and creative methods in promoting the health and well-being of individuals and communities, at the educational level, the development of courses in this field needs further strengthening (Corbin et al., 2021; Osman, Eacott, & Willson, 2018: pp. 28-33). Furthermore, arts and creativity-related health courses integrate existing pedagogical approaches and are typically led by educators and clinicians with a passion for the arts, without specific experience. The involvement of artists and art educators is quite low in both educational design and assessment processes (Osman, Eacott, & Willson, 2018: pp. 28-33). Scientists and health professionals, respectively, are turning to the arts and creative methods as tools to implement more effective and efficient health and wellness promotion interventions. At the same time, the need for training and specialization in the use of creative methods is expressed (Perry, Maffulli, Willson, & Morrissey, 2011: pp. 141-148).
Although some of the existing educational interventions based on the arts and creative methods seem to face issues in the description of the methodology, affecting the evaluation and evidence of their effectiveness (Perry, Maffulli, Willson, & Morrissey, 2011: pp. 141-148). Despite any possible methodological weaknesses and the need for further development displayed by the courses that use creative methods, their evaluation demonstrates the high degree of satisfaction of the students involved. The greater degree of empathy, and the holistic way of approaching and understanding the subject the course deals with are important benefits expressed by their students (Leyva-Moral et al., 2021). This was also found in the evaluation of the course of this study, where the students focused on the interactive nature of the course and assimilated the creative methods as tools.
Despite the important findings provided by the study, some limitations should be considered. Reliance on student self-reporting for course evaluation may introduce bias, as students might have skewed perceptions due to their involvement and effort. However, it is important to note that students were encouraged to answer the anonymous questionnaires honestly, without worrying about whether their responses were right or wrong. Additionally, the small sample size may limit the statistical power and representativeness of the results. Moreover, female students comprised the majority of the participants, which can increase the risk of bias and limitations that impact the generalisability of the results. Since this study was conducted as part of a project, the course evaluation could only be carried out by the students. Furthermore, the course was held online due to COVID-19, which may differ from in-person courses. In any case, the course syllabus is available online for any stakeholders to utilize and adapt to any context. Finally, it could be said that without longitudinal data, it is difficult to assess the long-term impact of the course on health promotion skills through creative methods. However, the aim of the study was to evaluate only the course.
5. Conclusion
The students who attended the postgraduate course and participated in the study perceived health as a holistic dimension, focusing on physical, mental, and social well-being. They described health promotion as a way of ensuring and improving health, highlighting the importance of facilitation and guidance. They referred to creativity as tools, innovative methods, alternative activities, interventions, and education approaches to health promotion. Regarding the course content, most students expressed great satisfaction with the creative activities, the interaction with foreign teachers, and the overall interactive nature of the course.
The literature supports the arts contribute significantly to the promotion of health and quality of life, either as a means of prevention and well-being, or as a tool for treatment and rehabilitation, applied to individuals and communities in different populations and environments (Clift, 2011: p. 8; Clift, 2020: pp. 77-83; Corbin et al., 2021). Therefore, the development of courses and curricula in higher education that integrate the arts and creative methods in teaching health promotion appears to be not just a challenge but an important need. Both for the holistic, more interactive learning experience of students, and for strengthening the tools and interventions of scientists and health professionals to promote the health and well-being of individuals or communities (Corbin et al., 2021; Robinson, 2007: pp. 173-180).
The current postgraduate course on health and well-being promotion through creative methods, co-developed in the framework of the ARTHEWE Erasmus+ project, could be an example of the implementation of similar courses in other university programs in the field of health promotion. Future studies, including follow-up assessments to evaluate students’ skills in health promotion using creative approaches, are suggested.
Furthermore, relevant learning materials (syllabus, PowerPoint presentations, art workshop guide, etc.) are available in English, online (https://arthewe.turkuamk.fi/) open access with creative commons license, and they could be utilised by any interested stakeholder and the academic community worldwide. This material may need adaptation to the cultural and institutional contexts of other regions or educational systems.
Funding
The publication of this article was financially supported by the Department of Special Account for Research Grants of the University of West Attica, Athens, Greece.