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Our review suggests that an overwhelming majority of studies have focused on HIV/AIDS, and that theatre-based approaches were the most common, but music and song, visual arts, storytelling and film have received sustained attention in the research literature.
Other studies (6/27 (22.2%)) worked with members of communities to produce music and song with health-improving or preventative intentions.90 93 95 98 101 104 In the Gambia, one paper reports how songs that encouraged bed net repair for malaria prevention were crafted by community members in response to a focus group discussion exploring malaria and prevention.90 The researchers leading this study facilitated the recording and circulation of these songs, accompanied by locally crafted posters, and found statistically significant improvements in bed net repair after communities were exposed to them. In South Africa, researchers explored the use of djembe drumming circles as an intervention to promote low-intensity to moderate-intensity physical activity.98 The study found that drumming was safe for hypertensives and was associated with a statistically significant reduction in blood pressure.
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All three of the papers which we identified as working explicitly with dance were part of multiform approaches.46 81 83 Two addressed HIV/AIDS46 81 and one focused on cholera and malaria.83 Given the lack of distinction between music, song and dance in many African traditions,107 it is likely that the apparently small number of dance-related studies identified in this review masks the extent to which dance was present in music and song-based studies.
Our review has identified the wide range of arts-based approaches that have been used within health promotion research in SSA. Theatre-based work was the most prominent among these approaches, but music and song, TV and radio, visual arts, storytelling and film-based work have all been explored, among others. The majority of these approaches have been mobilised as part of public health responses to the HIV/AIDS epidemic, but Ebola and malaria have also received some sustained attention. Other health conditions and issues have been explored with arts-based approaches, but in a more sporadic and isolated manner. The geographical spread of the research work is wide, with 30 of the 48 countries in the SSA region represented. However, as found in reviews of literature on other health-related topics in the region, South African-based research dominates.155
One of the significant achievements of arts-based approaches in SSA has been to reach and engage large numbers of people in health-focused reflection and action. The entertainment-education approaches applied in TV and radio have proven to be particularly capable of reaching large numbers with HIV/AIDS-related materials.111 115 Theatre-based work has also been shown to attract large numbers of people, both as audiences and as participants in organisations and initiatives, which have been characterised as a social movement.57 During Ebola outbreaks, popular25 and traditional101 music has also been used to reach large audiences. With the SSA region continuing to face a double burden of infectious diseases and non-communicable diseases (NCDs),159 these findings suggest that TV, radio, theatre and music are important tools for reaching populations and engaging them to reflect on health-related practices.