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

In the past 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 behaviors in observational studies. This, alongside a broader growing evidence base, has led to recent calls from the World Health Organization for the arts to be formally recognized as a health behavior. 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, which uses a socio-ecological approach to identify multilevel factors influencing patterns of arts behaviors. We end with recommendations for researchers incorporating questions on arts and cultural engagement within the design of longitudinal cohort studies.