The Pinnaroo Project: a longitudinal 3-year cross-sectional study of the impact of a community-based arts-in-health program on the health and wellbeing of a remote Australian community

INTRODUCTION: Rural and remote communities around the world face limited access to health and other services, often in the context of social, political, economic and environmental adversities. Evidence from WHO recognises art as a vital, non-invasive tool to enhance physical and mental health. The Pinnaroo Project was an arts-in-health project established by a remote rural community to address a dearth of locally available health services. METHODS: This study utilised a longitudinal 3-year cross-sectional study design from 2021 to 2023. The Pinnaroo Project team partnered with experts in creative art and Flinders University, which measured health outcomes during the evaluation period. All data were collected from community volunteers. RESULTS: The Pinnaroo Project developed more than 57 creative art experiences in 110 workshops, with high satisfaction (90%) reported from 616 feedback forms. During the 3-year evaluation period, there was a total of 564 health screenings with 66% (122 out of 186 participants in 2023) and 75% (126 out of 167 participants in 2022) reporting engagement in arts activities. Participation differed by gender, with higher engagement among females (64%; p<0.001). In the adults who participated in the arts, there was a significant reduction in self-reported depression (Patient Health Questionnaire score ≥5, decreasing from 31% in 2022 to 19% in 2023 (p=0.03) compared to no art (36% to 30%; p=0.53). In multivariable analyses after adjusting for demographic and clinical characteristics, arts participation was associated with a 62% lower likelihood of depression compared with non-participation (odds ratio = 0.38, 95% confidence interval: 0.19-0.79; p=0.01) Among children, a trend towards increased reported mental health difficulties was observed in arts participants; however, there was a 91% participation rate in the art activities among the local children, making the non-arts comparison subgroup too small (n=6) for comparison. Arts participants were 1.7 and 1.07 times more likely to meet recommended vegetable and fruit intake, respectively. Smoking prevalence was lower and fewer had elevated blood glucose levels. Quality-of-life scores were higher among all arts participants (children and adults) compared with non-participants. The economic modelling indicated there was an A$2.30 return on investment for every dollar invested in this initiative. CONCLUSION: The Pinnaroo Project demonstrated the success of rural communities leveraging alternative creative approaches to support population health, while developing a scalable evaluation model for implementation in similar settings. For every dollar spent on this project there was an A$2.30 return on investment to the community economics, which incentivises continuing investment.