Advancing observational research on arts and health: theory-informed approaches using the RADIANCE framework

In the last decade, there has been increasing observational research into the impacts of arts and cultural engagement on health, drawing on the surprisingly rich phenotyping of these behaviours in observational studies. This, alongside a broader growing evidence base, has led to recent calls from the World Health Organisation for the arts to be formally recognised as a health behaviour. However, access to the arts is not equitable, so a key challenge in observational research is disentangling any causal effects from this social gradient in engagement. In this paper, we consider five of the key methodological challenges in epidemiological research on arts and health and propose solutions by combining causal inference approaches with a new theoretical framework on the determinants of arts and cultural engagement (RADIANCE), which uses a socio-ecological approach to identify multi-level factors influencing patterns of arts behaviours. We end with recommendations for researchers incorporating questions on arts and cultural engagement within the design of longitudinal cohort studies.