University of Birmingham, Birmingham, UK
University of Birmingham, Birmingham, UK.
BMJ Open. 2024 May 17;14(5):e083093. doi: 10.1136/bmjopen-2023-083093.
Community-based arts interventions have the potential to support contextually relevant nurturing care programmes and policies that adapt to different settings. Understanding the distinctive features of using the arts in local, culturally specific ways in low/middle-income countries (LMICs); how this varies by context; and gaining a better understanding of the perspectives on desirable outcomes for communities is important evidence that this review generates.
We conducted a realist review of papers that covered outcomes related to child health or development (0-5 years) AND arts-based approaches AND community-based, participatory approaches AND based in LMICs using a range of databases and other networks. A coding framework was developed covering context, intervention, outcomes, mechanisms, study, sustainability, transferability and scalability.
The included papers reported 18 unique interventions. Interventions covered 14 countries, with evidence lacking for South America, Arab countries and parts of Africa. Lead authors came from mostly clinical science-based disciplines and from institutions in a different country to the country/countries studied. Intended outcomes from interventions included clinical, health systems/organisation, changes in practices/behaviours/knowledge/attitudes, and wider social and educational goals. We identified three demi-regularities (semi-predictable patterns or pathways of programme functioning): participatory design based on valuing different sources of expertise; dynamic adaptation of intervention to context; and community participation in arts-based approaches.
Our findings suggest that arts-based, nurturing care interventions have greater potential when they include local knowledge, embed into existing infrastructures and there is a clear plan for ongoing resourcing of the intervention. Studies with better documentation of the lessons learnt, regarding the intervention delivery process and the power dynamics involved, are needed to better understand what works, for whom and in which contexts.
基于社区的艺术干预措施有可能支持具有地方特色的、注重培养的关怀方案和政策，使其适应不同的环境。了解在中低收入国家（LMICs）以当地、文化特定的方式使用艺术的独特特征；了解这种方式如何因环境而异；并更好地了解社区期望的结果的观点，这是本综述产生的重要证据。
我们对涉及儿童健康或发展（0-5 岁）以及基于艺术的方法和基于社区的参与式方法的论文进行了一项真实主义综述，这些论文的研究范围涵盖了一系列数据库和其他网络。制定了一个涵盖背景、干预、结果、机制、研究、可持续性、可转移性和可扩展性的编码框架。
所包括的论文报告了 18 个独特的干预措施。干预措施涵盖了 14 个国家，但缺乏南美洲、阿拉伯国家和非洲部分地区的证据。主要作者来自以临床科学为基础的学科，以及与研究国家/国家不同的机构。干预措施的预期结果包括临床、卫生系统/组织、实践/行为/知识/态度的变化，以及更广泛的社会和教育目标。我们确定了三个半规律（半可预测的方案功能模式或途径）：基于重视不同专业知识来源的参与式设计；根据环境动态调整干预措施；以及社区参与基于艺术的方法。
我们的研究结果表明，当基于艺术的、注重培养的关怀干预措施包括当地知识、融入现有基础设施，并对干预措施的持续资源有明确计划时，它们具有更大的潜力。需要对干预措施的实施过程和所涉及的权力动态有更好的文件记录的研究，以便更好地了解哪些方法有效、对谁有效以及在哪些情况下有效。
