Year : 2022 | Volume
: 31 | Issue : 4 | Page : 371--373
The use of art-based interventions in the care of patients in health-care institutions in Nigeria: A review
Emmanuel Olusola Oladeji1, Constantine Ezeme1, Albert Seun Bamigbola2,
1 Department of Surgery, University College Hospital, Ibadan, Nigeria
2 Department of Surgery, Alimosho General Hospital, Lagos, Nigeria
Dr. Emmanuel Olusola Oladeji
Department of Surgery, University College Hospital, Ibadan
Background: Arts-based Interventions involve the use of aesthetic engagements, sensory activation, evocation of emotion and cognitive stimulation and involvement of the imagination, to promote wellbeing. This include a wide range of practices, from prehistoric traditions to the modern day evidence based usage of different forms of arts for therapeutic purposes. Despite the early recognition and proven efficacy of art-based interventions, an organized structure for integration of art into healthcare is lacking in Nigeria. Aim: This review aims to explore and describe the existing literature on the use of various art forms in the care of patients in health care institutions in Nigeria. Materials and Methods: A scoping review was done. MEDLINE, Embase, African Index Medicus and PsycINFO were searched using the following key words; art in medicine in Nigeria, art therapy in Nigeria and art in health in Nigeria. The search results were screened for articles using predefined criteria. A hand search for articles and communication with Arts in Medicine Project Nigeria were also done. The articles included in the review were read and summarized using a proforma. Result: Overall there is a sparseness of academic articles on the use and effectiveness of arts-based interventions in the management of patients in health care institutions in Nigeria. The most commonly applied art forms are music and visual arts.
|How to cite this article:|
Oladeji EO, Ezeme C, Bamigbola AS. The use of art-based interventions in the care of patients in health-care institutions in Nigeria: A review.Niger J Med 2022;31:371-373
|How to cite this URL:|
Oladeji EO, Ezeme C, Bamigbola AS. The use of art-based interventions in the care of patients in health-care institutions in Nigeria: A review. Niger J Med [serial online] 2022 [cited 2022 Oct 5 ];31:371-373
Available from: http://www.njmonline.org/text.asp?2022/31/4/371/354846
The relationship between medicine and art is agelong and complex. To put the scope of the interplay into perspective, it is important to state what health is according to the WHO Constitution and art as defined by Masoumeh. Health is a state of complete physical, mental, and social well-being and not only a mere absence of disease or infirmity while art is defined as the product or process of deliberate arrangement of items in a way that influences and affects one or more of the senses, emotion, and intellect of an individual. This idea of health underscores the fact that health goes beyond the traditional view of disease. Depending on the interest of the researcher, discussion of art in medicine (AIM) can take diverse forms. It is apt to state, however, that the evaluation of the different forms of art and how they influence specific aspects of medicine is beyond the scope of this review.
It is hard to tell at what point man started considering art as a healing tool because the quest for healing is as old as man and art is almost as old yet unless we place healing and practice of medicine in a context beyond disease as captured by WHO definition, the evolution of the practice of medicine will lose strong tie to art in early human history and practices in some cultures. This is because man did not see serious medical conditions as a natural phenomenon at first. The origin was regarded as supernatural and so is the nature of the therapy sorted.
In therapeutics, art has evolved with medicine. Broadly speaking, this includes a wide range of early human art practices, for example, by shamans, that were held in therapeutic view regardless of their overall medicinal value to the modern-day evidence-based usage of different forms of arts for therapeutic purposes. The biblical account suggests the use of music for a therapeutic reason. The use of flute and lyre to heal patients by Greek physicians, the use of vibrations to aid digestion, and an excerpt from Aristotle De Anima book are some of the early evidence of the use of AIM. One of the most compelling evidence of the influence of art is the 19th-century work of Diogel on the effects of music on physiologic parameters, blood pressure, pulse rate, respiratory rate, and improvements in the parasympathetic nervous system in general. Subsequently, various researchers have investigated the use of art in a vast array of conditions, including rheumatism, chronic pain, autism, late-life depression, Parkinson's disease, asthma; and the results are promising. While music seems to be more favoured in the early use of art in therapeutics, a lot of research into the application of AIM tends to use visual arts. Another form in which art is deployed in therapeutics in modern-day medical practice is art therapy, a term coined in 1942 by British artist, Adrian Hill. Art therapy is a form of expressive therapy that makes use of the creative process of making art to improve the person's mental, physical, and emotional well-being. It has garnered a lot of attention over the years and now has a whole field dedicated to it. It is a very active field of study with several positive results in clinical medicine.
The early history of education, healing, and art of geographical areas that formed Nigeria is largely orally transferred. Thus, much of what is known of art and healing are folklore and cultural antiques, some of which are still in practice in some rural areas. The study of AIM in its modern-day form has evolved with the practice of medicine and is championed by clinicians and academics.
The goal of this review is to evaluate the evolution of AIM and health, its application and challenges, and the future of arts in medical care in Nigeria.
Materials and Methods
A scoping review was done. MEDLINE, Embase, African Index Medicus, and PsycINFO were searched using the following keywords; AIM in Nigeria, art therapy in Nigeria, and art in health in Nigeria. The search results were screened for articles using predefined criteria which included art forms used in health-care settings on patients with a clinical diagnosis for the purpose of relieving symptoms or improving well-being. A hand search for articles and correspondence with Arts in Medicine Project Nigeria were also done. The articles included in the review were read and summarized using a pro forma.
Our search identified a total of 7102 records and an unpublished report from Arts in Medicine Project Nigeria. The articles were reduced to 37 after screening and subsequently to four articles and an unpublished account of the activities of the Arts in Medicine Project Nigeria. Two articles evaluated the effectiveness of music, one was on reduction of blood pressure among Grade I hypertensive patients and the other relief of pain and improved well-being in spinal cord injured patients. Two other articles evaluated the efficacy of visual art forms, one on improving self-expression and communication in autistic children and the other control of symptoms in patients with Parkinson's disease. The unpublished document gave an account of the use of various art forms in hospital-based patients but made no objective assessment of effectiveness.
In terms of studies and publications exploring the use of art in health in Nigeria, vast literature exists, as may be seen highlighted in different contexts with differing nomenclature. However, only a few were found in our search exploring the use of arts-based interventions in health-care institutions. The interesting dimensions explored by the articles identified are presented below. Two of the studies evaluated the effectiveness of music, one was on reduction of blood pressure among hypertensive patients, and the other was the relief of pain and improved well-being in cord injured patients., Using classical music, Ezenkwa found that music therapy significantly reduced both systolic and diastolic blood pressure in patients with essential hypertension. Although he used a small sample size of ten patients, he explained that music (especially the low rhythmic genre), has a modulatory effect on the listener's mood, feeling, and physiology which manifests in the vital signs as a reduction in the systolic and diastolic blood pressure (among other changes). Akinwumi and Mojoyinola, on the other hand, investigated the effectiveness of music therapy in the psychosocial management of patients with spinal cord injury. 120 participants were recruited for music therapy sessions twice a week for eight weeks, and parameters assessed include pain, physical, social, emotional, mental and spiritual well-being using the Music Therapy Assessment Questionnaire and Well-being Assessment Questionnaire. Using various genres of music, they demonstrated a significant reduction in the pain experienced and enhancement of the physical, social, and spiritual well-being of the cord injured patients. The two other articles evaluated the efficacy of visual art forms, one on improving self-expression and communication in autistic children and the other on control of symptoms in patients with Parkinson's disease. Abodunrin demonstrated that patients with Parkinson's disease who engaged in painting (a form of visual art) recorded improved emotional well-being and a greater decrease in stress and somatic symptoms. They also experienced enhanced memory and motor skills, improved imaginative skills, and enhanced self-expression. He argued that engagement in the complex cognitive exercise which engages visual, spatial, and motor coordination has a translational effect on a patient's overall motor and affective symptoms. In addition to painting, Quadri explored the use of other visual art forms in the management of behavioral difficulties experienced by children diagnosed with autism. He found that the most effective visual art forms were the least complex. Regardless of the intervention, however, the autistic children experienced improved imaginative thinking and self-expression and were also able to communicate and socialize better.
Some other equally important questions about the bearing of AIM have been researched by other authors. Olonite et al. discovered that the awareness of art therapy is high among clinicians while Modeme found the opposite among university academics. In terms of forms of art that people found most beneficial, Olonite et al. are again at variance with Abodunrin – dancing by the former and visual arts by the latter., However, particularly of note is the attitude of clinicians studied by Olonite et al. who found that most are willing to use art therapy if the resources to enable it are made available. Nonetheless, the difference in the level of awareness between the clinicians and non-clinician on one hand and the lack of global awareness among clinicians, on the other hand, shows a relatively poor general level of awareness of the use of art in modern-day medicine among Nigerians.
While the practice of AIM is still relatively new in Nigeria and it is too early to draw a conclusion on its knowledge and practice; the impressive reach of the AIM project of Tender Arts Nigeria is worthy of mention. Their use of bedside arts, live music performances, and other art engagements is well documented. Their reach extends to patients with sickle cell disease undergoing treatment at Sickle Cell Foundation Nigeria; children suffering from cancer at the Lagos University Teaching Hospital; patients at the Federal Neuro-Psychiatric Hospital Lagos; patients at COVID-19 isolation centers, and geriatric patients with cognitive impairment in care homes. The organization also has a unique fellowship program poised to grow a network of AIM practitioners across Nigeria, with an expanding continental and global reach. Although objective assessment of the effectiveness of their interventions was not reported, these efforts have the potential to increase the awareness about these practices among patients and health caregivers, and in so doing, stir conversations among clinicians. The Ministry of Health of Lagos State also initiated a project tagged art 4 life, envisioned to incorporate art into health care in a statewide campaign. It is especially targeted at improving the mental health and overall well-being of the state's citizens.
There has been a concerted drive by government agencies, nongovernmental organizations, and researchers to increase the awareness and adoption of arts-based interventions as an adjunct form of treatment in relevant cases. However, there is a paucity of academic articles on the use and effectiveness of these interventions in the management of patients in health-care institutions.
Mr. Kunle Adewale for his insightful contribution to the research topic and for kindly sharing his experience to demystify the different nomenclatures that are too often, misconstrued.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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