title: Social context, art making processes and creative output: a qualitative study exploring how psychosocial benefits of art participation during stroke rehabilitation occur.
abstract: OBJECTIVE
  To explore stroke survivors' and artists' beliefs about participatory visual arts programme participation during in-patient rehabilitation to identify benefits and potential mechanisms of action.
  
  
  METHODS
  Qualitative design using semi-structured in-depth interviews with stroke survivors (n = 11) and artists (n = 3).
  
  
  METHODS
  Data were audio-recorded and transcribed. Framework approach was used to identify themes and develop conceptual schemes.
  
  
  RESULTS
  The non-medical, social context of art facilitated social interaction, provided enjoyment and distraction from stroke and re-established social identity thereby improving mood. The processes of art making generated confidence and self-efficacy, setting and achievement of creative, communication and physical recovery goals that provided control over survivors' situation and hope for recovery. Creative output involved completion of artwork and display for viewing. This enhanced self-esteem and improved mood, providing survivors with new identities through positive appraisal of the work by others. Self-efficacy, hope and control appeared to mediate benefits.
  
  
  CONCLUSIONS
  This study provides a model of intervention components, mechanisms of action and outcome mediators to explain how art participation may work. Findings suggest that art may influence important psychosocial outcomes that other rehabilitation approaches do not typically address. The study paves the way for a future effectiveness trial.
  
  
  CONCLUSIONS
  Participation in an art programme during rehabilitation appears to improve stroke survivors' mood, confidence and self-esteem and enhances perceptions of hope and control over recovery. Social interactions, the processes of art making and review and appraisal by others may be key intervention components from which benefits are derived. Benefits from art participation may enhance survivors' experiences of rehabilitation and appear to provide benefits that other rehabilitation interventions do not. Art participation should be considered as an important adjunct to traditional rehabilitation.
authors.affiliation: a Social Dimensions of Health Institute, University of Dundee , Dundee , UK .|b Allied Health Professions Directorate, NHS Tayside , Scotland , UK .
authors.forename: Jacqui
authors.initials: J
authors.lastname: Morris
authors.affiliation: a Social Dimensions of Health Institute, University of Dundee , Dundee , UK .
authors.forename: Madalina
authors.initials: M
authors.lastname: Toma
authors.affiliation: b Allied Health Professions Directorate, NHS Tayside , Scotland , UK .|c Tayside Healthcare Arts Trust, NHS Tayside , Dundee, Scotland , UK .
authors.forename: Chris
authors.initials: C
authors.lastname: Kelly
authors.affiliation: d School of Psychology, Massey University , Palmerston North , New Zealand .
authors.forename: Sara
authors.initials: S
authors.lastname: Joice
authors.affiliation: a Social Dimensions of Health Institute, University of Dundee , Dundee , UK .
authors.forename: Thilo
authors.initials: T
authors.lastname: Kroll
authors.affiliation: e Centre for Clinical Brain Sciences, University of Edinburgh , Scotland , UK , and.
authors.forename: Gillian
authors.initials: G
authors.lastname: Mead
authors.affiliation: f Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling , Scotland , UK.
authors.forename: Brian
authors.initials: B
authors.lastname: Williams
mesh_terms: D000203:Activities of Daily Living; D000339:Affect; D000368:Aged; D000369:Aged, 80 and over; D001155:Art Therapy / Q000379:methods*; D005260:Female; D017144:Focus Groups; D065026:Hope; D006801:Humans; D007398:Interpersonal Relations; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D020377:Self Efficacy; D012931:Social Environment; D000071939:Stroke Rehabilitation; D017741:Survivors / Q000523:psychology*
keywords: Art; participation; psychosocial; stroke