The Use of Visual Arts in Healthcare Settings: Improving Patient Experience and Emotional Recovery
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Abstract
Hospitals increasingly use visual arts to support person-centered care, yet controlled evidence remains limited for programs that combine environmental artwork with facilitated art-making. This study estimated the program-level effectiveness of a combined visual-arts-enhanced care service and examined its implementation and explanatory processes. A multicentre pragmatic cluster-randomized trial with an embedded longitudinal mixed-methods process evaluation allocated 24 adult inpatient wards in six hospitals to culturally responsive environmental artwork plus up to four facilitated art-making sessions or to an attention- and time-matched non-art wellbeing program, both alongside standard care. Among 681 patients screened, 492 enrolled. We measured patient experience and reductions in psychological distress as co-primary outcomes at baseline, mid-intervention, discharge (the primary endpoint), and six-week follow-up. We integrated small-sample-corrected multilevel intention-to-treat models, multiple imputation, and multiplicity control with clinical records, implementation data, interviews, focus groups, observations, and reflective responses. At discharge, the intervention group had a 4.8-point higher person-centered care score (95% CI 1.8–7.8; g=.26) and a 1.7-point lower Hospital Anxiety and Depression Scale total score (95% CI −2.9 to −0.5; g=−.22). Follow-up estimates were smaller and included no effect. Positive affect and care satisfaction showed the clearest secondary differences, whereas pain, quality of life, opioid exposure, length of stay, and readmission did not differ reliably. Exploratory process estimates were associated with perceived control, emotion regulation, meaning-making, and social connection but did not establish causal mechanisms. Qualitative findings identified personhood, temporary distance from distress, choice, and connection alongside fatigue, cultural mismatch, and performance pressure. The combined program was associated with modest short-term experiential and psychological advantages during admission, contingent on voluntary participation, cultural relevance, facilitation quality, and coordination with ward routines.
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