Correspondence to: Priscilla Robinson, School of Public Health, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria 3086. Fax: (03)9479 1783; e-mail: email@example.com
Installation art involves using everyday objects and spaces in an unusual way to gain attention and encourage interaction. While arts-based projects have the ability to inform and provoke interest, few have focused on public health. Oddsocks was conceived as a public health installation as part of the annual Melbourne Fringe Festival, with a primary aim to raise awareness concerning the importance of exercise and foot health. Promoting such underserved public health issues creates specific challenges which have been typically under-reported. This methods paper focuses on how these challenges can be met through arts-based initiatives and arts-based inquiry.
The arts, including the visual, literary, performing and environmental arts, create the means and the media for personal expression in the public domain.1 Multi-modal creative and expressive arts have been used as interventions in health care for some decades. The innovative and typically expansive ways of experiential learning and knowing, facilitated through interacting with the arts, have been articulated by Heron and Reason (1997) in their exploration of a participatory inquiry paradigm.2 As McNiff (1998) states, ‘Artistic knowing is different than intellectual knowing; this distinction is the basis of its creative value’ (p36).3
Installation art is a particular form of the visual arts and constructs an environment for active participant engagement. It can deliberately blur distinctions between art and life, introducing as a result new ways of experiencing familiar settings. Through this process, narrative and sensory experience merge,4 with the potential to deepen knowledge and encourage public discourse.5 Arts-based inquiry and interventions assume many useful forms, including the development of particular evaluation methodologies,6 through to therapeutic applications, such as art therapy.7
Despite the capacity for arts-based projects to inform and provoke interest, it appears few have focused on public health. Some projects have addressed socio-economic problems, which may indirectly influence public health;8 community-based arts and health projects have also been undertaken. However, it has been reported that while many of these projects involved the use of art to improve health and well-being, the aims were diverse and not completely clear.9
OddSocks was conceived as a public health installation as a part of the annual Melbourne Fringe Festival, and serves as a specific example of how an arts-based approach can be developed as a vehicle for health promotion. The main aim of the installation was to promote an understanding that many health benefits are achieved by caring for the feet, an aspect of personal health which is often ignored. Our primary objectives were threefold: a) to raise awareness about the importance of foot health, b) to provide helpful self-management strategies and information about exercise and foot care, c) to provide referral to relevant health care professionals and services. These aims gave rise to several secondary objectives: i) to deliver health messages to the public in imaginative ways, ii) to involve health sciences students in engaging fieldwork beyond the classroom setting, iii) to allow participants to interact with the installation in a variety of meaningful ways, including listening, learning, and storytelling. Another aim of the installation was to provide information and raise funds for two NGO projects: an Oxfam project, and a Faculty of Health Sciences skills transference program which trains Cambodians to make prosthetics for landmine victims.
The basic OddSocks module is a transportable clothes line mounted in a concrete base, with socks attached to the clothes lines using conventional clothes pegs (Figure 1). Public liability insurance was provided by the University, and the data collection phases of the project granted ethical approval by the Faculty Ethics Committee. OddSocks was an unfunded project. Registered as an official 2007 Fringe Festival event,10 it featured as part of the festival for 10 days (10 days for 10 toes). The full installation was situated at a central and highly visible city location outside St Paul's Cathedral, Melbourne (Figure 2), and took place from 10 am to 7 pm, weather permitting.
The complete installation consisted of three clothes lines covered in odd socks (i.e. unmatched) which were donated by the general public. It was attended by staff members and chaplaincy of the University, as well as podiatrists, a physiotherapist, and students from the Schools of Public Health and Podiatry. As such, many had either a broad or specific knowledge of foot health issues. It was understood that delivery of the public health messages and interaction with the public would be spontaneous; however, when uncertain, all were encouraged to provide referral to specialist services.
Information was disseminated either via written material, or verbally from healthcare professionals on site. In keeping with the theme, pedometers, pamphlets and brochures were displayed in cloth peg-baskets within easy reach. Examples of topics included: foot health for children, exercise, diabetes, physiotherapy, podiatry, ‘walk 10,000 steps a day’ optimal exercise message and walking-trail maps. Images of socks to colour in (Figure 3) and sock puppets were provided to encourage parents with children to participate; intriguingly, we found these items were popular with adults as well as children.
In addition, the public were able to ask specific questions to the podiatrists on site. Those who stopped could self-select information, or seeks answers to specific concerns. Overall, members of the public were encouraged to engage with the installation in any way they preferred.
A methodology was developed to gauge responses, including the recording of public reactions, as well as interactions between installation staff and the public. As part of this process, we undertook systematic counts of participant and non-participant passers by. A participant was considered to be a member of the public who stopped and interacted with the installation and health promotion materials in any way. A passer-by was considered to be an individual who passed in either direction on the same side of the street as the installation. Although we were aware that many people were discussing the installation without stopping, these were not included as active participants.
To gain further insights regarding the potential impact of the installation, a daily diary documenting main observations was distributed via email to the project team as part of the evaluation process. Entries recorded direct feedback from participants, as well as information pertaining to those who made a special effort to attend the installation, or those who returned for repeated visits.
Findings and Discussion
People interacted with the installation (see Table 1) in many ways.
Table 1. Active versus inactive participants.
Did not stop
Percentages represent percent of total passers-by who participated
Sat 2:45 pm to 3:15 pm
Sat 4:05 pm to 4:35 pm
Sun 3:00 pm to 3:30 pm
Sun 4:00 pm to 4:30 pm
Mon 11:30 am to12.00 pm
Total: 2 hrs 30 mins
Among those who stopped and spoke with OddSocks staff, some found information about the project via the internet and the Fringe event guide. This suggests collaborating with a cultural event can raise the profile of arts-based public health initiatives, potentially aiding attendance and promotional efforts. A number of people had observed OddSocks for several days prior to deciding to visit, suggesting familiarity can also contribute to the likelihood of participation over time. A number of participants returned with pedometers they considered to be faulty, prompting discussion about just how far 10,000 steps really is! Attending staff observed leaflets were typically retained, and not discarded on the ground or destroyed within the parameters of the installation, and some people returned to collect additional leaflets, suggesting participants found the information to be useful, therefore addressing one of the project's key primary objectives.
Interactions from active participants assumed various forms: asking questions, selecting health promotion materials, providing comments, and on occasion expressing outrage about irrelevant peripheral political and social issues (highlighting some of the challenges when presenting an installation in a public setting). Participants interacted with the installation in predictable, spontaneous and surprising ways, as expected with installation art.
Participants variously photographed the installation, told stories, added, rearranged or even souvenired socks. One gentleman asked to take two socks to wear, since he did not possess any; a sobering example of an installation's ability to reach beyond its initial objectives. Accordingly, this process underscores the importance of considering such spontaneity when planning arts-based initiatives. Such examples also illustrate the accessibility of the installation, and by extension, access to the information provided. All participants had to do was walk by.
It is noteworthy that particularly interesting relationships and interactions developed between OddSocks staff and the people who lived locally on the street. At times, the street kids were active in helping us to provide information to passers-by. This dynamic indicates the importance of setting, and how the locality can influence attendance, participation, including a willingness to be involved.
Arts-based enquiry is increasingly understood to offer valuable methods for participatory enquiry research and research with vulnerable populations or on sensitive topics. This suggests it is useful and relevant to public health projects.11,12
However, only limited information exists about the public health benefits of the Arts.9
It should be mentioned, and we specifically acknowledge, that providing information and referral does not automatically signify a corresponding increase in health outcomes; for example, health outcomes cannot be determined through counting leaflets distributed, socks coloured in, or the number of steps counted on a pedometer. However, future endeavours, such as a replication of this installation or comparable projects, could consider an analysis of each separate component if measurement of such outcomes was required. Examples could include follow-up in-depth interviewing of participants, observational studies of interaction, recording and transcription of ‘sock stories’, and follow-up of behavioural changes made following information gained; all of which are beyond the scope of this paper. In addition, monitoring these outcomes was not part of our objectives, since this was an exploratory, proof-of-concept project.
Given the course of events throughout the 10 days of the installation it would appear that we achieved all our primary and secondary objectives. Using OddSocks as a starting point, we plan to develop further ways of measuring public health benefits through using the Arts in public health activities. Further studies that will flow on from the installation include a thematic narrative analysis of the sock-stories, an observation study of the lifespan of the installation, and a content and thematic analysis of the several thousand photographs taken during the installation period. We will also write up the method for using this project as a teaching tool.
The idea behind OddSocks is simple and transportable. It is also infinitely adaptable; we have already been asked to repeat it in four very different locations. As an installation it appeared to work well, with people interacting to various degrees with it. We believe we were able to effectively deliver a set of public health messages through establishing a participatory arts-based health promotion project, as per our outlined aims and objectives. Given the exploratory nature of this initiative, we plan to further develop OddSocks, including quantitative and qualitative ways of measuring its impact.
We wish to acknowledge the staff and students of the Faculty of Health Sciences and La Trobe University, Meagan Chiuchiarelli for practical assistance with the project, the members of the public who participated in the project and the various businesses and organisations that provided practical support for OddSocks.