The review was guided by The Joanna Briggs Institute’s (JBI) Methodology for JBI Scoping Reviews (Peters et al., 2017). This methodology provides an overview of evidence in a research area, with a systematic process for literature searching, screening, and analysis. It was conducted as one of two scoping reviews that were part of a larger project focusing on the use of the arts in community health settings in the United States. The first scoping review examined arts-based programs in health communication (Sonke et al., 2021b). A protocol for the entire project, inclusive of both reviews, was registered with the JBI in January 2019, under the preliminary title “Engaging the Arts in Health Communication and Wellbeing: A Scoping Review.”

After title and abstract and full text screening by AC, JS, VP, MC, and SH, 44 studies were included in the final review. Of these, there were 11 doctoral dissertations, 1 master’s thesis, and 5 reports. The remaining 27 records were original research articles (PRISMA Diagram, Supplementary Figure 1).

The combined study populations of the included results represented a total of 5,080 research participants. The sample size ranged from 8 to 1,198 with a mean of 134 and a median of 21. Additionally, 178,000 participants were included in an evaluation report (Pourat et al., 2018). The various target populations were described by race/ethnicity (e.g., Indigenous, Black, African American, Latinx, Chinese, Filipino, and Burmese), age (e.g., older adults, adolescents, youths, students, and adults), profession or activity (e.g., laborers, farmers, musicians, and dancers).

Most articles (n = 34) focused on how arts interventions were used to improve wellbeing in marginalized populations. The study used two complementary concepts to form its definition for marginalized populations. The first oriented toward power imbalance, “marginalization as a multidimensional, dynamic, context-dependent, and diverse web of processes, rooted in power imbalance and systematically directed toward specific groups and individuals, with probabilistic implications for development” was used for the analysis (Causadias and Umaña-Taylor, 2018). And the second oriented toward identities, recognizing exclusion due to gender identity, race, age, sexual orientation, physical ability and/or immigration status (Baah et al., 2019). For the analysis, the definitions given by the study authors were used. Older adults were considered those 55–64 years old, and elderly were considered those 65 or older.

Populations identified in the studies included indigenous (n = 5), African American/Black (n = 7), immigrant (n = 5), elderly or older adult (n = 7), young adult (n = 2), youth and children (n = 2) and women and girls (n = 7). For example, Ka’Opua et al. (2016) addressed intergenerational connection and cultural resilience between native Hawaiian young adults and elders through an active-participatory storytelling curriculum. Kitwana (2014) used ethnographic methods and active-participatory dance to explore holistic wellbeing (psychological, physical, and social) needs in African American/Black adults (n = 7). Mares et al. (2020) addressed self and collective perceptions of felt and real structural forms of violence and vulnerability in Latinx day-farmworkers in Vermont through a combined comic-book and gardening intervention. Harrison et al. (2020) addressed perceptions, beliefs, opinions, and attitudes about physical activity and exercise in 58 urban-residing elderly minority individuals. Brown (2017) used the Social Justice Youth Development framework to address trauma, racialized gender oppression, and healthy development in African American/Black youth through an artistic expression program designed to facilitate healing. Deng (2017) investigated the effects of museum-based experiences on learning and behavioral outcomes in children with autism. Finally, McConnell et al. (2016) addressed gendered oppression through semi-structured interviews with participants of the Michigan Womyn’s Music Festival (Table 1).

Study designs were identified by the researchers and coded by VP and AC. Two broad categories emerged: outcomes research studies and descriptive studies.

The first study design category, outcomes research, included studies that measured results of an arts intervention or reported results of being engaged in the arts on wellbeing. This category included the subcategories of evaluation, community-based participatory research (CBPR), experimental, correlational, and model testing.

The seven evaluation studies appraised programs or curricula. Outcome evaluation studies are designed to measure the program goal. These designs can involve both quantitative and qualitative methods. All these studies reported psychosocial and cohesion outcomes. For example, Brown (2017) evaluated a “Healing Space of Refuge” youth development program for Black youth and found that the program contributed to cultural cohesion and improved family relationships. Ka’Opua et al. (2016) evaluated an oral history curriculum for school-aged children utilizing native Hawaiian elders’ stories, finding increased knowledge of social responsibility and intergenerational connection.

Nine studies used community-based participatory research methods as identified by the studies’ authors. This research approach is often used by public health organizations with populations that experience marginalization. The community-based participatory research (CBPR) approach involves a process wherein researchers and community stakeholders act as equal partners in the research process. The goals generally are educating the community, improving practice, or social change (Tremblay et al., 2018). Of these methods, participatory action research, community-based participatory research, or Photovoice were identified by the study authors. The CBPR articles concentrated on community involvement and assessment for the development of programs (n = 2), evaluation of art-based programs (n = 3), and to understand the health and wellbeing of a population (n = 4). Of note, MacAulay et al. (2019) utilized CBPR to develop and evaluate a music training program for older adults, finding statistically significant (p < 0.05) improvement in executive function, global cognition, verbal fluency, visual memory performance, self-efficacy, and emotional wellbeing.

There were four studies that used Photovoice methodology. Photovoice is “a public health strategy in which underserved individuals use photography and narratives to identify, record, and share their personal and community health experiences” (Catalani and Minkler, 2010). Teti et al. (2017) used Photovoice to provide mental health support for women living with HIV. This was found to facilitate expressing emotions, address distress and process trauma, which led to empowerment.

Experimental studies are used to establish evidence of causation. Essential elements include manipulation of the independent variable, a control group, and random assignment of subjects to a study group (Gray and Grove, 2021). The three randomized control trials included two studies of older adults using, drama, and choir interventions (Moore et al., 2017; Johnson et al., 2020). These interventions produced findings of increased self-esteem, confidence, happiness and interest in life, and decreased loneliness. A study of a 4-week journaling intervention of parents found a decrease in negative affect (Ahmed, 2017).

Correlational studies establish the strength and direction of relationships between variables (Gray and Grove, 2021). There were four correlational studies. A longitudinal correlational study on musical training on cognition in older adults was conducted by Gooding et al. (2014). A correlation was found between the ability to read music and increased performance on the Animal Naming Test (ANT; semantic verbal fluency) and Logical Memory Story A Immediate Recall (LMI; episodic memory) measures. An association was found between cognitive reserve and improved late-life episodic and semantic memory.

Additionally, Strong and Midden (2020) compared cognition of adult instrumental musicians (active vs. former) and non-musicians. A standardized neuropsychological battery and self-reported measures of levels of physical activity, social activity, and overall health were used. All musicians (active and former) had higher scores on the Boston Naming Test and Controlled Oral Word Association compared to non-musicians. Active musicians scored highest on the Stroop task (Delis-Kaplan Executive Function System: Color Word Interference), indicating that cognitive benefits (in the domain of language) of early life music lessons continue into late life.

Model testing is correlational research methods that measures proposed relationships in a theoretical model (Gray and Grove, 2021). A study by Meeks et al. (2018) tested flow state as a model of psychological benefit from theater, finding that theater had an indirect effect on individual and community wellbeing across all ages. Travis and Bowman (2015) used a comparative correlational design to test a measure of empowerment and risk in association with music engagement and its application to the individual and community.

Descriptive studies describe the characteristics of an individual, situation, group, or population (Gray and Grove, 2021). A total of 17 descriptive studies focused on describing program participants’ perceptions, motivations, meaning, and attitudes in relation to arts interventions. These studies had quantitative (n = 3), qualitative (n = 5), and mixed methods (n = 6) designs and included ethnographies (n = 3) and reports (n = 5, the reports are not counted as studies). For example, Ja’s (2014) study of high school students found that students participating in performing and fine arts programs reported higher autonomous motivation than students in academic clubs. Doğan and Timothy (2020) evaluated the effect of ecomuseums on the Ak-Chin tribal community, finding positive social and cultural benefits for the entire community.

Ethnographies (n = 3) included a study of West African dance on mental health that found improvements in emotional regulation, maintaining presence, and addressing diasporic stressors (Kitwana, 2014). McConnell et al. (2016) explored the Michigan Womyn’s Music Festival and found it promoted adaptive responding, including safety, empowerment, self-expression, and sense of community with other women.

The reports in this review identified projects and studies which met the protocol criteria. Five reports were not research studies but did evaluate programs (O’Brien, 2016; Pourat et al., 2018; Campbell, 2019; Lamar, 2019; Sonke et al., 2019). Programs included Healing in Motion which used Dance Movement Therapy to help heal Post Traumatic Slave Syndrome (Campbell, 2019). Similarly, the Move 2 Love dance program was developed to support physical and social wellbeing in older women and has operated for over 23 years. The evaluation reported addiction avoidance, increased physical activity, and increased social and psychological wellbeing (O’Brien, 2016).

Lamar (2019) found that a program to connect museum art collections to the native peoples whose culture the art collection represented increased community wellbeing. Pourat et al. (2018) evaluated Parks After Dark, a program designed to increase access to high quality recreational activities in poorer neighborhoods of Los Angeles County. The authors reported positive changes in all six of their goals, including lowered rates of violence and greater perceptions of safety among participants, as well as increased physical activity, social cohesion, and perceptions of community wellbeing.

A report by Sonke et al. (2019) presented art programs in the United States that addressed collective trauma, racism, mental health, chronic disease, social exclusion, and social isolation. The programs described cross sector collaboration between community development, public health, and arts and culture (Table 2).

The arts forms used in the interventions were grouped either by a specific type of art form (e.g., music, dance, theater, and literary) or mixed art forms (i.e., two or more art forms). Additionally, they were grouped by type of involvement, either active participation or receptive participation (Turino, 2008; Story et al., 2021).

Active participation was the most prevalent mode of arts involvement in the reviewed studies (n = 38). Active participation by dancing, playing an instrument, singing (music), acting in a theater production, or journaling (literary art) are examples. Art forms included mixed arts (n = 14), dance (n = 9), music (n = 8), theater (n = 3), literary arts (n = 2), and storytelling (n = 2). Participation in dance programs (n = 9) were found to be a low cost, enjoyable and culturally appropriate means to accessible physical activity for children and adults with positive benefits to physical, social, and psychological wellbeing (Kitwana, 2014; Moe, 2014; Feinberg et al., 2016; O’Brien, 2016; Schroeder et al., 2017; Atkins et al., 2018; Campbell, 2019).

Literary arts interventions included journaling for parents and creative writing for a junior college geology course (Ahmed, 2017; Porias, 2020). Storytelling included oral histories with indigenous elders (Ka’Opua et al., 2016). The mixed active participation art forms included photography/visual arts and storytelling (n = 4), weaving and storytelling (n = 1), architecture, design, and planning (n = 1), multiple arts and cultural activities n = 1), music and storytelling (n = 1), music and architecture (n = 1), music concerts and musicals (n = 1), and visual and literary (n = 1).

Receptive participation includes watching a performance or engaging in cultural activities (n = 6) (Small, 1998; Turino, 2008). Of the art forms with receptive participation, cultural activities i.e., museum visitation (n = 3), theater (n = 2), and music concerts (1) were included. Overall, participation in these art forms indirectly related to satisfaction and enjoyment of theater events, hedonic wellbeing, social functioning via flow states, sense of belonging, and social engagement. The mixed receptive participation art forms included musical theater and concerts (n = 1).

This category included studies of activities that engaged people in both active art-making and observation of arts programming. Four studies containing both active and receptive mixed arts participation (e.g., physically dancing and watching a dance performance) were included. Zitcer et al. (2016) gathered qualitative and quantitative data in three adjacent West Philadelphia neighborhoods to determine the strategic value of arts/culture engagement upon community empowerment. In interviews study participants stated the importance of the arts, its value, and the contribution to improve their overall quality of life. Specifically, participants discussed how the arts improve the lives of children. They found that the arts engage children and provide outlets for youth and perceive that this improves the safety of their neighborhoods (Table 3).

This review considered wellbeing as reported in the included studies at the individual and community levels. In keeping with Dodge et al. (2012), individual wellbeing was framed around three components—psychological, social, and physical. Individual wellbeing that included all three characteristics was considered “holistic wellbeing.” In keeping with Robert Wood Johnson Foundation [RWJF] (2019), community wellbeing was defined as how “communities experience and evaluate their lives.” Each article was coded and categorized as individual or community. Further, the studies were coded as psychological, social, physical, and holistic.

For example, the research presented by Strong and Midden (2020) assessed individual differences between older adult musicians and non-musicians that continue or discontinue playing into late life. The study by Evans and Liu (2019) addressed individual and psychological wellbeing. Their quantitative research investigated the effects of participation in a high school orchestra on members’ self-esteem. In contrast, at the community level, the study by Mares et al. (2020) assessed several arts interventions designed to address structural violence and structural vulnerability that effect the wellbeing of farmworker communities. Of note, participatory dance programs were found to benefit participants on a holistic level. Findings show positive results on physical, social, and psychological wellbeing (Kitwana, 2014; Moe, 2014; Feinberg et al., 2016; O’Brien, 2016; Schroeder et al., 2017; Atkins et al., 2018; Campbell, 2019).

The included articles reported several types of research outcomes. These outcomes were coded utilizing the taxonomy by Dodd et al. (2018). This taxonomy was used in a recent scoping review (Golden et al., 2019). In this taxonomy the outcomes are divided into a core area and a subdomain. wellbeing outcomes were found in two core areas: Life Impact and Resource Use. Most studies reported outcomes in the Life Impact domain with Emotional Functioning/Wellbeing (n = 21) and Social Functioning (n = 19) as the most common areas of focus. In the subsequent paragraphs, Life Impact including social, emotional, and physical functioning, global quality of life, and cognitive functioning is followed by Resource Use including economic and hospital/healthcare.

Emotional functioning is defined as the “impact of disease/condition on emotions or overall wellbeing (e.g., ability to cope, worry, frustration, confidence, perceptions regarding body image and appearance, psychological status, stigma, life satisfaction, meaning and purpose, positive affect, self-esteem, self-perception, and self-efficacy)” (Dodd et al., 2018). Reported outcomes in this area included increases in self-awareness, self-esteem, happiness, confidence, self-efficacy, grit, vitality, sense of self-achievement, experience of flow, positive attitude toward aging, autonomy, competence, motivation, empowerment, psychological safety, and feeling valued, as well as reductions in negative affect and mental health distress (n-21). For example, in a study of the effects of a 6-week Drama Workshop program, Moore et al. (2017) found that participants reported positive changes in happiness, confidence, and self-esteem post-treatment.

Social functioning refers to “the impact of disease/condition on social functions (e.g., ability to socialize, behavior in society, communication, companionship, psychosocial development, aggression, recidivism, participation)” (Dodd et al., 2018). The findings in these studies included increased social cohesion, social activity, social connectedness or a decrease in social isolation/loneliness, or social exclusion after attendance in a class or arts intervention (n = 19). For example, social interaction skills in children with autism were found to improve after several visits to an art museum (Deng, 2017).

Seven publications reported that arts interventions impacted physical functioning, defined as “physical activities of daily living (for example, ability to walk, independence, self-care, performance status, disability index, motor skills, sexual dysfunction, health behavior, and management)” (Dodd et al., 2018). Participatory dance affected physical functioning in all studies. Outcomes reported included improved physiologic wellbeing, lowered disease burden, prolonged life, more energy, a stronger body, and increasing physical, social, and psychological fitness (Kitwana, 2014; Moe, 2014; Feinberg et al., 2016; O’Brien, 2016; Schroeder et al., 2017; Atkins et al., 2018; Campbell, 2019). For example, Schroeder et al. (2017) studied an intergenerational program for children and adults in an urban community (n = 521), finding positive physical benefits as well as increased community engagement and enjoyment.

Five studies measured global quality of life. In these studies, the measurement was accomplished by using several quality of life and wellbeing measures, such as the Quality of Life AD (Kahle-Wrobleski et al., 2016), Satisfaction with Life Scale (SWLS) (Diener et al., 1985), and the Psychological Wellbeing Scale (PWB) (Diener and Biswas-Diener, 2009). Three of these studies did not find a statistically significant change in global quality of life after the arts intervention. Two studies, Ja (2014) and Meeks et al. (2018), reported a positive increase in global quality of life measures. In a study of theater involvement in Vandenbroucke and Meeks (2018) found a significant difference in global quality of life related to theater involvement (philanthropy and volunteers) and attendance (subscribers and attendances) (All measurement instruments used in studies in this review can be found in Supplementary Table 6).

Five studies addressed cognitive functioning, defined as the “impact of disease/condition on cognitive function (e.g., memory lapse, lack of concentration, and attention), outcomes relating to knowledge, attitudes and beliefs (e.g., learning and applying knowledge, spiritual beliefs, and health beliefs/knowledge)” (Dodd et al., 2018). Results reported by Gooding et al. (2014); MacAulay et al. (2019), and Strong and Midden (2020) demonstrated cognitive benefits of music. Cantu and Fleuriet (2018) found that painting, drawing, mixed media, and creative writing enhanced the ability to focus among older adults.

This category included articles that assessed utilization of economic resources and hospital use. Two studies assessed resource use relating to food and water. Mares et al. (2020) used storytelling along with community gardening, and a participatory comics and storytelling intervention to address issues of food insecurity and barriers in access to fresh and culturally familiar produce with goals of fostering mental health, participation in a free clinic, and education of the public about farmworkers vulnerability. Mitchell (2016) utilized Photovoice (visual arts and storytelling) to engage members of the Kickapoo Tribe in identifying the effects of water insecurity in their community.

Johnson et al. (2020) measured hospital resource use and other healthcare costs, including hospital use, in their study of a community choir for older adults. They reported a near tripling of health care costs for the control group and a doubling of costs for the intervention group over a 6-month period (Table 4).

This review found evidence that arts interventions can have negative outcomes. Moore et al. (2017) found lower anxiety in a control group than those in a drama workshop intervention group. In a study of the effect of listening to rap music on college students, among other findings, Travis and Bowman (2015) reported a higher likelihood of thinking about engaging in sexual activity, drinking alcohol, and marijuana use when listening to rap music than when listening to most other types of music. Surprisingly, there were no completely null findings in any of the publications included in this review (see Extracted Data for All Publications, Supplementary Table 7).

Scoping reviews have limitations. Notably, they do not provide a critical appraisal of publications, which limits generalizability of findings. The aim of a scoping review is to overview the evidence related to a particular question (Munn et al., 2018). While systematic reviews are used in evidence-based healthcare to guide clinical decision making and practice, a scoping review is used primarily to identify types of evidence and examine how research is conducted (Munn et al., 2018). Since there were no other reviews that addressed the use of the arts in wellbeing in the United States specifically, a scoping review of the evidence was deemed an appropriate approach. However, the limits of this approach are recognized in regard to the usefulness of findings.

The review included articles published over a 7-year period and interventions completed within the past 12 years, which limited the volume of findings. As noted, the varied and broad definitions, interpretations and concepts of the arts and wellbeing, posed challenges to the development of search terms and inclusion/exclusion criteria as well as analysis of the evidence. The lack of consistent outcomes measures and variation in research designs was evident. While there are benefits to these varied approaches, they pose challenges to presenting an overview of the evidence. This scoping review was conducted at the beginning of the COVID-19 pandemic, too early to capture work specifically being done around the arts and wellbeing in the pandemic context. There is a growing field of literature on this topic which should be investigated as the pandemic continues to unfold.