1. Is engaging in visual/ tactile art based activities associated with improved health and well-being in refugees and asylum seekers?
2. Are specific art based activities or modes of engagement associated with specific effects or experiences?
No publication date limits will be applied. Only studies available in English will be accessed. The searches will be re-run immediately before the analysis so that recently published studies will also be included. Unpublished data will not be sought or included. Where studies meet the inclusion criteria, their bibliographies and google scholar will be used to identify further eligible studies, either referenced by or citing the included study.
The following electronic databases will be searched for primary studies:
AMED, Allied and Complementary Medicine Database
A&HCI, Arts and Humanities Citation Index
BNI, British Nursing Index
CINAHL, Cumulative Index to Nursing and Allied Health Literature
Cochrane Central Register of Controlled Trials (CENTRAL)
ERIC, Education Resources Information Center
EMBASE, Excerpta Medica Database
HEED, Health Economic Evaluations Database
JBF, Joanna Briggs Foundation
MEDLINE/ PubMed, U.S. National Library of Medicine
NHS EED, National /health Service Economic Evaluation Database
PILOTS, The Published International Literature on Traumatic Stress
PsycINFO, American Psychological Association
SCI, The Science Citation Index
SSCI, The Social Sciences Citation Index
Taylor & Francis Online
WOS, Web of Science
The following electronic databases will be searched for systematic reviews which may include relevant studies:
Cochrane Database of Systematic Reviews (CRSRs)
DARE, Database of Abstracts of Reviews of Effects
PROSPERO, International Prospective Register of Systematic Reviews
Search terms and synonyms that relate to visual and tactile art activities will be combined with search terms and synonyms for the target population.
Types of study to be included
Empirical intervention studies including:
Randomised controlled trial study design including cluster randomised controlled trials and crossover randomised controlled trial study design.
Non-randomized trial study design (quasi-experimental/ controlled trials)
Pre and post study design provided that data from a comparator group are reported.
Cohort studies provided that data from a comparator group are reported.
Case control studies.
Quantitative, qualitative and mixed methods research will be included.
Non-comparator studies such as case studies and case series.
Condition or domain being studied
Mental health including but not limited to Post Traumatic Stress Disorder (PTSD), anxiety and depression. Well-being.
Refugees and Asylum Seekers as defined by the 1951 Refugee Convention
Internally displaced people not classified as refugees
International migrants who are not refugees or asylum seekers
Refugees or asylum seekers who have returned to the country they sought refuge from.
Studies with a mix of refugees/ asylum seekers and other migrants will be included. Studies where the population group is not specified as including refugees or asylum seekers will be excluded.
No exclusion will be made on the basis of age, gender, ethnicity, employment or socio-economic status.
No exclusion will be made on the basis of immigration status other than that above.
1. Art therapy. Group or individual therapy provided by a Health and Care Professions Council (HCPC) registered art therapist or equivalent, internationally. Art therapy is not limited to health care, and while the practice is varied, its parameters are often defined through a professional body and state registration. In the UK this is the British Association of Art Therapists (BAAT) and the HCPC. Art therapy is defined by the BAAT as ‘a form of psychotherapy that uses art media as its primary mode of expression and communication. Within this context, art is not used as diagnostic tool but as a medium to address emotional issues which may be confusing and distressing.’ (BAAT website 2016). Practitioners may have particular theoretical affiliations and may specialise with a particular service user group or condition. The mainstream objectives of art therapy are to facilitate emotional and psychological change or growth. The potentially central use of art and the explicit potential therapeutic relationship are key factors. Art therapy is usually provided on a regular, weekly basis and can be short term or long term.
2. Participatory art, artist led. Groups or individual activities provided by an artist where the service users have a participatory role. This may include making, handling or active viewing of art. Active viewing of art will be defined as involving some level of tangible role on the part of the service user, above that of perception. They may be asked to discuss the art, or reflect upon their feelings at the time of the interventions as opposed to afterwards in an evaluation.
3. Art classes or art appreciation where the focus is on learning a technical skill or about art theory or history
4. Art activities, non-artist led. This will include the facilitation of service users doing art by a person other than an art therapist or artist, or where the majority of the responsibility falls to somebody outside of those two stated roles. This will include activities led by occupational therapists, other professionals or volunteers.
5. Art on prescription. This is visual or tactile art programmes where the attendees have been referred by a GP or another healthcare practitioner. There is an explicit art making, viewing or handling role for the participants.
6. Non-participatory art making and art displays, including artist residencies where an artist is making artwork on-site. Exhibitions or displays of two or three-dimensional artwork displayed with no formal interaction between artwork and service user set up as part of the intervention. If the art is made by the service user then those studies would be included in the category in which they were created, most likely to be participatory arts. The impact this work has on independent viewers will be included in this category. Here the role is one of audience, receiving the work but not involved in an earlier part of the creative process.
8. Self initiated art activities. This will also include any studies that look at self directed art activities where artistic activities not instigated or supported by an external agent.
Studies where participants simultaneously receive an interventions from the included list and an intervention from the excluded list will be included.
Excluded interventions and exposures
1. Non-visual or non- tactile arts such as singing, music, poetry, literature, dance and drama
2. Non-arts-based groups or activities- gardening, social groups, cooking, walking, exercise or sport, meditation, self-care, life skills, verbal therapy, games or interest groups other than art.
3. Film and video activities that include audio features will not be included.
Active comparators including any intervention, activity or exposure that are not visual/ tactile art based.
Inactive comparators including waiting list, standard care and treatment as usual.
Health, education, community settings as well as refugee camp and detention settings
No exclusions will be made on the basis of the setting.
1. Mental Health
1.1 PTSD symptoms
1.2 Depression symptoms
1.3 Anxiety symptoms
1.4 Other mental health outcome
2.1 Quality of Life
2.2 Other well-being outcome
3.1 Return to work/usual activities
3.2 Commencement of new work or activities
3.3 Other social outcome
4.1 Exhibition, display or publication
4.2 Independent art practice, artist identity
4.2 Other artistic outcome
5. Adverse effects
5.1 Worsening of symptoms
5.2 Any other adverse effect
Data extraction, (selection and coding)
KP will carry out the search strategy. Two reviewers, KP and EB will independently scan the title, abstract and keywords for all records obtained. Full text articles will be obtained where the study is deemed of potential relevance to the search criteria. These will be screened for inclusion by KP and EB. Discrepancies and disagreements over eligibility will be identified and resolved through discussion with a third reviewer if necessary. Data extraction will be done by KP using a standardised and piloted electronic data extraction form. Data extraction will be checked by EB.
Risk of bias (quality) assessment
Risk of bias during selection, performance, attrition, detection, and reporting or studies will be assessed by two reviewers, KP and EB using CASP where appropriate for study design and another relevant published quality assessment tool. Sensitivity analyses is planned to test the effect of removing poor-quality studies.
Strategy for data synthesis
Narrative synthesis is planned. A meta- analysis is not planned due to the expected heterogeneous nature of the studies.
Analysis of subgroups or subsets
1. Intervention/ activity type, as defined in question 20 above.
2. Intervention/ activity mode i.e. group or individual
3. Intervention 'dosage' i.e. intensity and duration
4. Diagnostic / symptom group
5. Severity of symptoms / condition
6. Stated affinity with intervention prior to engagement
7. Concurrent prescribed drug use
8. Effect size
9. Sustainability of intervention effects
10. Co- morbidity
The findings of the review will be of interest and useful to art therapists and artists working in health care as well as other health and social care professionals such as GPs, service users, service commissioners, policy makers and other researchers. The findings will have multi-disciplinary relevance. The literature will be reviewed to find the most appropriate dissemination framework to reach the prioritised target audiences. A combination of face to face and mass media channels will be used. A summary report will be produced.
With regard to reaching art therapy and art professionals the findings will be edited to produce articles for various journals, including
• International Journal of Art Therapy (formerly Inscape), Taylor & Francis
• Arts & Health, An International Journal for Research, Policy and Practice, Taylor & Francis
• Journal of Applied Arts & Health, Intellect Ltd
• The Arts in Psychotherapy, Elsevier
• Inter-professional Care, Taylor & Francis
• The International Journal of the Creative Arts in Interdisciplinary Practice (IJCAIP)
• Journal of Creativity in Mental Health, Taylor & Francis
• Journal of Psychiatric and Mental Health Nursing, Wiley
• The British Journal of General Practice, Royal College of General Practitioners
• The Journal of Traumatic Stress
• International Migration Review
• Journal of Refugee Studies
Press releases relating to the review will be written and released via relevant networks, include the following
• News briefing, The British Association of Art Therapists (www.baat.org)
• Arts & Health South West (http://www.ahsw.org.uk/)
• Arts Professional (http://www.artsprofessional.co.uk/)
• The National Alliance for Arts, Health & Wellbeing (http://www.artshealthandwellbeing.org.uk/)
• The International Health Humanities Network (http://www.healthhumanities.org/)
It is anticipated that elements of the research will be presented at local, national and international conferences while the research is underway to stimulate interest in the project. Applications will be made to present the findings at relevant conferences such as
• Arts and Health South West: Culture, Health and Well-being International Conference, June 2017
• Arts and Health South West: Annual Conference 2017
• British Association of Art Therapists’ Art Therapy Practice Research Network: Annul Conference
• The Royal Society for Public Health: Arts, Health and Well-being Special Interest Group Conferences
Social media will be utilised where appropriate. The author has established a dedicated Twitter account for building a network of relevant contacts. It is anticipated that the findings from the review will inform reports by organisations including the What Works Network and the Royal Society for Public Health Special Interest Group on Arts, Health and Well-being.
Contact details for further information
University of Derby
Organisational affiliation of the review
University of Derby
Ms Kate Phillips, University of Derby Ms Emily Bradfield, University of Derby Professor Susan Hogan, University of Derby Professor David Sheffield, University of Derby Dr Charley Baker, University of Nottingham
Professor Catherine Meads, Anglia Ruskin University
Anticipated or actual start date
31 March 2017
Anticipated completion date
31 January 2018
University of Derby
Conflicts of interest
Subject index terms status
Subject indexing assigned by CRD
Subject index terms
Art Therapy; Humans; Refugees
Stage of review
Date of registration in PROSPERO
29 March 2017
Date of publication of this revision
06 June 2017
Stage of review at time of this submission
Piloting of the study selection process
Formal screening of search results against eligibility criteria
Risk of bias (quality) assessment
PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites.