Peer-reviewed article
Coproduced, arts interventions for nurturing care (0–5 years) in low-income and middle-income countries (LMICs): a realist review
Nicola Kay Gale, Kalim Ahmed, Niélé Hawa Diarra, Semira Manaseki‐Holland, Evans Atiah Asamane et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This realist review examined community-based arts interventions designed to support nurturing care for children aged 0–5 years in low- and middle-income countries. The review identified 18 unique interventions across 14 countries, finding that successful approaches typically involved participatory design, adaptation to local context, and community engagement. The review notes significant geographic gaps in evidence, particularly for South America, Arab countries, and parts of Africa, and highlights the need for better documentation of how interventions are delivered and how power dynamics affect outcomes.
Key points
- Arts-based interventions with greater potential included those that incorporated local knowledge, embedded into existing infrastructures, and had clear plans for ongoing resourcing
- Three semi-predictable patterns emerged across interventions: participatory design based on valuing different expertise sources, dynamic adaptation to context, and community participation in arts approaches
- Evidence covered 14 countries but had significant geographic gaps, with limited studies from South America, Arab countries, and parts of Africa
- Intended outcomes ranged from clinical and health systems goals to broader changes in practices, behaviours, knowledge, attitudes, and social and educational goals
- Lead authors were predominantly from clinical science disciplines and institutions in different countries than those studied, suggesting potential misalignment with local contexts
Limitations
This is a realist review of existing literature rather than a primary evaluation, so it does not directly measure intervention outcomes. The review identifies what features appear important but cannot definitively establish causation or determine effectiveness across different settings.
Abstract
OBJECTIVES: 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. DESIGN: 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. RESULTS: 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. CONCLUSIONS: 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.