Multilevel effects of Expressive arts-based intervention on psychological and spiritual wellbeing of elderly via ambassador training

Abstract

<p><strong>Introduction:</strong> Expressive Arts-based intervention (EABI) is an innovative treatment that allows the elderly to express their feelings through arts creation. The present study aimed to evaluate the effects of the EABI in promoting mental health of the elderly via trainings of ambassadors.</p><p><strong>Research Design:</strong> A single group pre-post design was adopted. Eighty-four healthcare workers in Hong Kong received the EABI training as an ambassador and delivered the 8-week EABI to 915 elderly between 2017 and 2021. The elderly completed assessments on depressive symptoms, spirituality, and quality of life (QoL) and the ambassadors completed measures on self-efficacy before and after the training. Intervention effects were examined by paired t-tests and multilevel path modeling on the associations among the changes.</p><p><strong>Results:</strong> The elderly reported significant improvements in depressive symptoms, spiritual well-being, and QoL (d = 0.37 - 0.91, <em>p</em> < 0.01) and the ambassadors reported a significant increase in self-efficacy (d = 0.53, <em>p </em>< 0.01). Greater increases in ambassadors’ self-efficacy showed significant indirect effects on greater decreases in depressive symptoms and greater increases in QoL via changes in spiritual wellbeing.</p><p><strong>Conclusions:</strong> The findings suggest beneficial effects for both ambassadors in terms of self-efficacy and elderly in terms of spiritual and mental well-being. These provide empirical support to the viability of using the train-the-trainer approach in providing clinical interventions.</p>