Developing a transcultural arts-based participatory approach to exploring the drivers of diabetes and hypertension among African communities in Scotland and Malawi

Bissett, Maria (2025) Developing a transcultural arts-based participatory approach to exploring the drivers of diabetes and hypertension among African communities in Scotland and Malawi. PhD thesis, University of Glasgow.

Abstract

Background: African communities in Scotland and Malawi are disproportionately affected by noncommunicable diseases (NCDs), including diabetes and hypertension. There is a need to understand the specific socio-cultural drivers of these diseases among different communities to develop health promotion interventions that are effective and sustainable. Arts-based participatory approaches are a collaborative strategy to explore underlying experiences of NCDs using creative activities (e.g. music, drawing). A transcultural model which values multiple perspectives and diverse cultural identities, could support the development of a methodology that can be adapted and applied with diverse communities to generate culturally-situated insights into NCD risk factors and inform culturally compelling health promotion interventions. This research aims to develop a framework for a transcultural arts-based participatory approach (TABPA) to explore the drivers of diabetes and hypertension among African communities in Scotland and Malawi.

Methods: This research involved close collaboration with community members, local arts-practitioners, and stakeholders in each setting, and was carried out in three phases to develop a TABPA framework for wider implementation. Phase 1 involved a familiarisation process with communities in Malawi and Scotland. Walkalong interviews (N= 8 Malawi: N=10 Scotland) were used to explore local perspectives on community, NCDs, and local art forms. Three single-gender community workshops (Malawi: N=10 gender and N=12 gender, Scotland: N=11 women) were used to determine what art forms would be compatible with community interests and adaptable to explorations of NCDs, and how participants would respond to arts based participatory workshops in practice. Finally, two stakeholder workshops (Malawi: N=10 in-person, Scotland: N=4 online) were conducted to learn more about community capacity for arts-based health research from the perspectives of key local stakeholders.

Phases 2 and 3 involved the pilot and refinement of the TABPA in Scotland (Phase 2) and Malawi (Phase 3). Single-gender TABPA workshops were piloted with women in Scotland (N=12) and men Malawi (N=10) before being refined and conducted with women in Malawi (N=10) and men in Scotland (N=3). The TABPA workshops followed a simple, flexible, scaffolding structure, using arts-based activities to explore community perspectives on the risk factors of diabetes and hypertension. Data from all three Phases were analysed using reflexive thematic analysis.

Findings: Phase 1 walkalong interviews in both Malawi and Scotland generated a deeper understanding of the local contexts that would shape community involvement in the TABPA workshops. In Malawi, participants defined community as belonging to “one family” within their local area. In Scotland, definitions of community were more complex, with many participants seeing themselves as belonging to several communities at one time. In both settings, communities were concerned about diabetes and hypertension, were knowledgeable about risk factors, including diet and stress, and several had personal or familial experiences of the diseases. Many participants indicated that they had experience of arts-based activities through community events (Malawi), community organisations (Scotland) and places of worship (both). However, community members in each setting revealed barriers to participation in arts, such as a lack of time or opportunities. These insights informed the design and implementation of the Phase 1 community and stakeholder workshops, which highlighted that a range of art forms including music and dance, drama, drawing, and poetry, could be effectively used to explore hypertension and diabetes, especially if they are culturally engaging (e.g. music) and accessible (e.g. drawing). Offering flexibility and choice over the art-form and the content fostered participant engagement, relationship building and co-learning. Stakeholders in each context also highlighted the importance of supporting workshop accessibility (e.g. by providing reimbursement for travel and childcare).

The Phase 2 and 3 TABPA workshops were initially informed by the Phase 1 findings and refined using learnings from initial pilot implementations in both countries. The workshops used a scaffolding structure consisting of five activities including games, individual visualisations, creative group activities, performance and reflection. Community members used drama, song, drawing and storytelling, and shared culturally-situated understanding of the risk factors of diabetes and hypertension (e.g. social prestige as a driver of unhealthy eating in Malawi and the impact of the UK immigration on health behaviours in Scotland). Participants also shared personal and emotive narratives about how they and their families had been impacted by diabetes and hypertension and reflected positively on the TABPA workshops as a space where they felt “free” to express their views. However, the workshops also highlighted power dynamics during the co-production of knowledge, such as differing expectations regarding whether the workshops should include health information dissemination and diverging expectations around the quality of the artistic outputs. Overall, the TABPA workshops supported the model and highlighted that community involvement in the development could support a culturally-compelling research design.

Conclusions: Although this research was developed and conducted in diverse contexts, the TABPA workshops appeared promising as a means to gain culturally-situated insights into the drivers of diabetes and hypertension in each community. Thus, while the need for Phase 1 will depend on the practitioner’s familiarity with the community, this research presents a TABPA framework consisting of: i) a familiarisation phase to gain in-depth understanding of the target community and local context; and ii) a scaffolding TABPA workshop protocol to explore community perspectives and experiences of NCD risk factors. Recommendations for future implementation of the framework by researchers and practitioners are provided including the importance of flexibility, supportive facilitators and responsiveness to community and practitioner expectations.

• Item Type: Thesis (PhD)
• Qualification Level: Doctoral
• Subjects: R Medicine > R Medicine (General); R Medicine > RA Public aspects of medicine; R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
• Colleges/Schools: College of Social Sciences > School of Social and Political Sciences
• Supervisor's Name: Bunn, Professor Christopher and Gray, Professor Cindy
• Date of Award: 2025
• Depositing User: Theses Team
• Unique ID: glathesis:2025-85507
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 07 Oct 2025 15:19
• Last Modified: 08 Oct 2025 11:50
• Thesis DOI: 10.5525/gla.thesis.85507
• URI: https://theses.gla.ac.uk/id/eprint/85507