Identifying and defining implementation strategies for Arts on Prescription

Background
Arts on Prescription (AoP) has emerged as an approach within social prescribing, offering non-clinical, community-based interventions to improve mental health, well-being and social outcomes. AoP programs typically entail group sessions over a period of 8-12 weeks where participants engage with arts, cultural, and creative activities. These programs foster cross-sectoral and interdisciplinary collaborations to address complex health challenges, promoting both individual well-being and resilient community systems. However, creating sustainable AoP programs that promote equitable access and preparedness across sectors entails navigating significant implementation barriers. For example, lack of communication between third-sector organizations and healthcare services, unclear roles and responsibilities among stakeholders, and lacking competences among involved link workers and artists.

Aim
Despite the growing interest in AoP, implementation strategies addressing implementation barriers for AoP programs remain underexplored and knowledge to facilitate the development and implementation of sustainable AoP programs is limited. Therefore, this study aims to identify and define implementation strategies for implementing AoP programs.

Methods
Drawing on realist synthesis methodology, this study involves insights from a literature review and stakeholder perspectives in a three-step process: first, identifying implementation strategies in published research literature on AoP; second, gathering stakeholder perspectives on implementation strategies through workshops including stakeholders from the international project Arts on Prescription in the Baltic Sea Region; and third, synthesizing insights from the first two steps to produce a unified set of strategies for implementing AoP programs.

Results
The synthesis resulted in the identification of 48 implementation strategies, grouped into five thematic clusters: 1) Awareness of AoP, 2) Capacity Building, 3) Evaluation, 4) Facilitating AoP Experiences, and 5) Organizational Setup, Collaboration, and Infrastructure. These clusters encapsulate relevant implementation strategies relating to all phases of implementing AoP programs, i.e. from early adoption to securing sustainable programs that are continuously adopted to changing needs and opportunities in the community.

Conclusion
This study, to our knowledge, is the first to assess implementation strategies for AoP programs and provides a comprehensive list of implementation strategies. These strategies can guide decision-makers and public health professionals to foster preparedness and promote equitable health by offering actionable insights into building resilient systems that integrate arts-based interventions into healthcare and community settings. This contributes to the development of sustainable AoP programs that can support healthier communities. Our next step is to investigate how, for whom, and under what circumstances these strategies work, which can guide planners and practitioners to prioritize and tailor their approaches effectively.