Enhancing Wellbeing in Community Dwelling Seniors Through Structured Arts-Based Programmes in the Active Ageing Centres: A Mixed Method Study.

The study will be conducted at selected AACs. Using a mixed method design, integrating both quantitative and qualitative approaches to evaluate the effectiveness of structured arts-based programs for seniors by assessing the mental wellbeing of the seniors.

The quantitative approach of the study will recruit 239 subjects using purposive sampling. To evaluate the effectiveness of the structured arts program, among the 239 subjects, 170 subjects are actively engaged in the structured arts-based program conducted in the 14 AACs. 69 are non-participants (control) who are not participants in the structured arts-based program are recruited from different AACs which do not conduct the program in the AACs.

Both participants and non-participants (control) will complete questionnaires to evaluate the primary and secondary outcomes measures. This will be conducted in the AACs at their time of convenience upon obtaining informed consent. The questionnaires will be done on FormSG for data collection. To understand the mental wellbeing (primary outcome of the study), it is to measure using the 14-item Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS), a validated instrument measuring the different aspect of positive mental health. (Tennant et al., 2007)

The secondary outcomes are participant satisfaction, depression and anxiety, health-related quality of life, and social isolation. The scales used to measure these outcomes are the Patient Health Questionnaire (PHQ-9); EuroQol 5-Dimensional (EQ5D-5L); General Anxiety Disorder 7-Item (GAD-7); Patient-Reported Experience Measures (PREMS). These scales would be collected at baseline (T0), after 4 to 6 sessions of arts program (6 weeks after baseline for non-participants (control) (same amount of time as participants group) (T1), 6 months post-intervention (T2) except PREMS will be collected at T0 and T1. The questionnaire at T0 and T1 will be done face to face while questionnaire at T2 will be done face to face or through phone.

The qualitative approach of the study will recruit 30 participants and 6 non-participants (control) who did not participate in the structured art-based program into the focus group discussion. The focus group discussion will be conducted in group of 5-6 subjects in a conducive space within the AACs. Each will be guided with a topic guide which will take 60 - 90 mins face to face at ±14 days from T1 (Appendix).

In addition, eight artists and four stage managers involved in the structured art-based program will be recruited and interviewed through focus group discussions. These will be conducted in groups of 4-5 subjects, at a location and preferred time that is convenient for the participants. The focus group discussion will be guided with a topic guide which will take 60 -90 mins face to face.

Up to 14 AAC staffs and one producer of the structured arts program will be recruited for semi-structured interviews. The face-to-face semi-structured interviews will take 45-60 mins, following an interview guide for the AAC staffs and the artist FGD topic guide for the producer, at a preferred time and location of the participants.

All qualitative interviews will be audio-recorded and transcribed verbatim for analyses. All identifiable information will be mased or removed during transcription to ensure participant confidentiality.

For triangulation with the data from the surveys and qualitative interviews, the observation notes which the implementation team has been collecting for feedback to National Arts Council routinely since 5 November 2025 will be included during our data analyses. The observation form was adapted from the INNATE Framework (Warran, Burton and Fancourt, 2022) with additional focus on participants' and program implementers' behaviours, interactions (without personal identifiers) and environmental context relevant to the research questions.