Museum Management and Curatorship
ISSN: 0964-7775 (Print) 1872-9185 (Online) Journal homepage: http://www.tandfonline.com/loi/rmmc20
Generic well-being outcomes: towards a
conceptual framework for well-being outcomes in
museums
Erica Ander , Linda Thomson , Guy Noble , Anne Lanceley , Usha Menon &
Helen Chatterjee
To cite this article: Erica Ander , Linda Thomson , Guy Noble , Anne Lanceley , Usha Menon &
Helen Chatterjee (2011) Generic well-being outcomes: towards a conceptual framework for
well-being outcomes in museums, Museum Management and Curatorship, 26:3, 237-259, DOI:
10.1080/09647775.2011.585798
To link to this article: http://dx.doi.org/10.1080/09647775.2011.585798
Published online: 24 Jun 2011.
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Date: 01 June 2016, At: 21:47
Museum Management and Curatorship
Vol. 26, No. 3, August 2011, 237259
Generic well-being outcomes: towards a conceptual framework for
well-being outcomes in museums
Downloaded by [Duke University Libraries] at 21:47 01 June 2016
Erica Andera, Linda Thomsona, Guy Nobleb, Anne Lanceleyc, Usha Menonc and
Helen Chatterjeea*
a
UCL Museums & Collections, University College London, Wolfson House, 4 Stephenson Way,
London NW1 2HE, UK; bUniversity College London Hospital Arts, University College London
Hospitals NHS Foundation Trust, Ground Floor Rosenheim Wing Grafton Way, London WC1E
6DB, UK; cGynaecological Oncology, UCL Elizabeth Garrett Institute for Women’s Health,
Maple House, 149 Tottenham Court Road, London W1T 7DN, UK
(Received 5 August 2010; final version received 23 December 2010)
The concept of well-being is now widely used in policy, including in the museum
sector. This article addresses the need for museums to understand and be able to
measure their contribution to this increasingly important instrumental value, if
they are to engage with the policy. However, due to the indefinite and inconsistent
definition of the concept, it is difficult to know what to measure. There are also
difficulties capturing this amorphous outcome to allow for generalisability and to
assign causality the key needs of policy-oriented research and evaluation. The
article outlines these issues and looks at psychology, economics, healthcare and
culture for insight. It also suggests a tentative Well-being Outcomes Framework
that could be used consistently in the sector, to measure evidence and advocate for
museums’ contribution to well-being.
Keywords: museums; museum management; well-being; evaluation; evaluation
framework; social responsibility
Introduction
A new policy priority is being advanced in the United Kingdom (UK) museum
sector agenda. It links with both the healthcare and local government sectors-in fact,
‘Virtually every realm of public policymaking and service delivery in advanced
capitalist nations is now influenced by notions of Quality of Life (QOL) and wellbeing’ (Galloway and Bell 2006, 2.1). One could see this as merely a shift in
terminology describing goals to which museums have traditionally contributed.
Nevertheless, museums have the opportunity to closely engage with this broad
agenda and, in return, benefit from its strength as a priority with funders and
partners. Under their learning, inclusion, access, outreach and audience development
programmes, museums are already having an affect on well-being and, indeed, have
had throughout much of their history. The challenge, as with learning, is measuring
the idiosyncratic but potentially significant contribution museums make to
individual and community well-being, and articulately advocating for further work
to potential partners and funders.
*Corresponding author. Email: h.chatterjee@ucl.ac.uk
ISSN 0964-7775 print/ISSN 1872-9185 online
# 2011 Taylor & Francis
DOI: 10.1080/09647775.2011.585798
http://www.informaworld.com
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238 E. Ander et al.
The added difficulty with well-being is the lack of consensus on its definition and
measurement, even before looking at culture’s contribution. With the introduction in
the UK of the Generic Social Outcomes (GSOs) a framework developed and
promoted by the Museums, Libraries and Archives Council (MLA) to evaluate social
outcomes in museums, libraries and archives several museums are already working
towards healthcare and well-being aims. Such engagement, however, requires robust
theoretical and empirical evidence and a conceptual language to be valued as such.
Defining, measuring and describing well-being in a cultural context, and potentially
to non-cultural partners, is a key challenge that this article addresses. It proposes a
consistent and standardised framework of well-being outcomes in the Generic
Learning Outcomes or GLO model. The GLOs gave ‘museums, archives and
libraries a means of understanding, analysing and talking about learning-the
development of a conceptual framework’ (Research Centre for Museums and
Galleries [RCMG] 2003, 7). A Well-being Outcomes Framework may do the same for
well-being and allow museums to understand and promote this area of their work.
Well-being in policy
Why do museums need to take account of this new term ‘well-being’? In the last couple
of decades it has become a concern of many local and national governments that have
become disillusioned with the traditional use of gross domestic product (GDP) or
income as a measure of their citizens’ happiness, health and wealth. Governments have
been introducing new indices of progress and well-being to guide their policy-making
(they also sometimes call well-being ‘happiness’). They often include dimensions of
life such as time use, health and well-being, community involvement, environment and
healthy populations, rather than income. This has happened all over the world,
including initiatives in France where President Sarkozy has introduced 10 ‘happiness’
indicators to measure progress in the nation (Bacon et al. 2009); in Canada where the
Canadian Index of Wellbeing (2010) is being used; in Australia with the Measures of
Australia’s Progress (Australian Bureau of Statistics 2010); in Europe where the
European Social Survey includes a module on well-being (New Economics Foundation [NEF] 2009), and in Bhutan where the Gross National Happiness Index (Gross
National Happiness, the Centre for Bhutan Studies 2010) uses nine dimensions to
measure progress. The Organisation for Economic Co-operation and Development
(OECD) co-ordinates international efforts to measure progress through its Measuring
the Progress of Societies programme (OECD 2010). At a local level, numerous
projects to measure community well-being have been started throughout the world at
a city, district and state level.
Whereas well-being used to be seen as an unspoken goal of governments through
their various policies for health, equality, the economy and education, they have now
become ‘more direct and honest in describing well-being as a legitimate goal in itself’
(Bacon et al. 2010, 11). As publicly funded institutions or ones which exist for the
public good (whatever their funding), museums are part of the shift towards this
holistic conception of human progress and need to engage with its meaning.
Culture’s appearance in many of these notions of national well-being, in fact, favours
museums in a way previous, less qualitatively-based, government priorities did not.
The concept of well-being’s very broadness and openness brings culture to the same
policy table as other major policy goals such as health, education and the economy.
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Museum Management and Curatorship 239
In the UK, a number of government policies have come into place such as ‘Every
Child Matters’, ‘Youth Matters’ (UK Department for Children, Schools and
Families 2010), the local and central government agreed priorities (Local Government Association 2002) and Local Area Agreements (UK Department for
Communities and Local Government 2010) all of which consider well-being
a priority. Many UK museums, particularly those funded by Local Authorities, are
aware of these policies and in some way attempt to integrate with them as a way of
showing value and credibility to their funders and governors. Another milestone in
moving well-being towards the centre of policy was the mandate local authorities
were given to improve ‘economic, social and environmental well-being’ for the first
time (UK Parliament Local Government Act 2000), which promotes crossdepartment working and joined-up services. The UK healthcare sector’s policy
priorities also considered newly holistic ideas in delivering services, looking to
preventative medicine, multi-agency approaches and the promotion of well-being
(MLA 2004).
Mental health is another important policy area that has been seen in recent years
as a cross-agency issue, sometimes substituting for well-being itself. Mental health is
integrated strongly with local government areas such as housing, environment and
schools, as well as with public health amongst the wider population (UK
Department of Health 2009). The deterioration of mental health in the modern
world is recognised as costly (estimated at £77 billion per year in the UK) and
damaging to nations, impacting on, and caused by, a number of other priority areas
(Jenkins et al 2008). Mental health is seen as starting with promoting ‘protective’
factors in the general population, as well as identifying risk factors early on and
providing good quality care when mental health has already deteriorated (UK
Department of Health 2009).
The appearance of the term well-being in UK museum policy and strategy can be
traced back through the MLA commissioned research into GSOs (Burns Owen
Partnership [BOP] 2005), and the New Directions in Social Policy documents (MLA
2004). The BOP research showed that very little specific activity, and virtually no
evaluation of ‘health and well-being’ outcomes, had been or were being undertaken
by museums (or was not being labelled as such). This document also presumed that
any work museums, libraries and archives would do in this area would be in the field
of mental health. This presumption continues in more recent policy and research
documents (MLA 2007b, 2008). The GSOs, a framework for museums to evaluate
their programmes were developed, however, with a major strand called ‘health and
well-being’ with an aspiration to fill in those gaps found in the BOP research. The
GSO’s sub-outcomes within this included ‘encouraging healthy lifestyles and
contributing to mental and physical well-being’; ‘supporting care and recovery’;
‘supporting older people to live independent lives’, and ‘helping children and young
people to enjoy life and make a positive contribution’ (MLA 2010a). In contrast to
the GLOs, which were developed from research with museum users, the GSOs were
mainly developed from central government policy. Thus their use is perhaps more
difficult in museum practice. In addition, libraries appear to have been seen as
the main potential for health and well-being outcomes in the museums, libraries and
archives sector in England (MLA 2004, 2007a, 2007b, 2008; MLA, South East 2008).
240 E. Ander et al.
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Museum practice
Despite the focus on libraries, museums are gaining confidence in citing their unique
contributions to well-being. Well-being outcomes could be said to go back centuries
in museums (Classen 2005; Keene 2005), but the idea of activities specifically labelled
for well-being is more recent. Museums, as well as libraries, have been involved in
health literacy such as the ‘Health Matters’ exhibition at the Science Museum,
London (UK), the Wellcome Collection’s exhibition programme, and several
exhibitions exploring and displaying issues around mental illness (e.g., Museum of
Croydon, Manchester Art Gallery, Great North Museum, The Lightbox, Woking all in the UK). In the US, the Association of Children’s Museums (ACM) has
introduced the ‘Good to Grow’ initiative that sees children’s museums as a major
way to inform and encourage healthy lifestyles through family activity (ACM 2010).
Beyond health literacy, museums’ contributions to well-being could be very
important in terms of building personal resources, the prevention of problems,
and de-medicalising health and well-being. This view is increasing among the highest
levels of the medical establishment, as quoted in a recent report by the editor of the
British Medical Journal:
Indeed the physical aspects of health may be the least important. We will all be sick,
suffer loss and hurt, and die. Health is not to do with avoiding these givens but with
accepting them, even making sense of them. If health is about adaptation, understanding and acceptance then the arts may be more potent than anything medicine has
to offer. (Richard Smith cited in Culture Unlimited 2008)
Museums, as part of the arts, could be seen to be effective in helping mental illhealth sufferers but also in maintaining mental health and affecting emotional wellbeing changes in people experiencing physical health issues. An advocacy report,
Museums of the Mind (Culture Unlimited 2008), presents evidence of museums’ role
in underwriting mental health and emotional well-being, and lists the special
characteristics of museums in terms of emotional well-being as: their pedigree in
philosophy, poetry and art happiness-promoting phenomena; their collection of the
stories and artefacts that are the meaning of life; their strength in ‘perspective’ perspective of time and their various visitors’ perspectives; they see the person, not
the illness; they have artefacts which communicate in 3D and spark emotions and
imagination; they do not sell anything; museum spaces are calm sanctuaries;
museums are a collective memory bank and an anchor for our mental health; and
museums are not medicalised or compulsory (Culture Unlimited 2008).
This agrees with much of what museum workers know when they witness people
exploring their museums. They know museums are free-choice (and therefore
accessible) learning environments and deal in identity, memory, the senses and
insight all valuable for mental health including dementia. There are already some
good examples of museums targeting well-being audiences, particularly the Museum
of Modern Art (MoMA) in New York, which has run a groundbreaking programme
for people with dementia and their caregivers with very positive results (MoMA
2009). There is also a group of museums in the UK’s North West region working
with mental health audiences.
The intrinsic power of objects themselves is a strength yet to be fully explored in
well-being, although University College London (UCL) Museums and Collections
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Museum Management and Curatorship 241
held a series of workshops in 2008 and has published two books (Chatterjee 2008;
Pye 2007) exploring the power of touching objects. This special engagement, long
noted in museum learning evaluations, can also contribute to well-being. There are a
few museums in England working specifically with objects within healthcare
institutions and hospitals.
Reminiscence, using objects from living memory, is the familiar activity that
museums have developed with elderly groups and for which well-being seems a major,
if not always, an explicit, aim. The objective is to keep elders’ minds active, stimulate
memory, value their life experiences, sustain communication, and stem confusion.
Reading Museum (UK) has begun a programme of reminiscence in care homes, as
have National Museums Liverpool and a large number of local museums in the UK.
Dulwich Picture Gallery and the Fitzwilliam Museum, Cambridge, UK (Nightingale
2009) have branched out to work with dementia and Alzheimer’s sufferers. In
Denmark, Den Gamle By, an open-air museum, has worked with elderly people and
people with dementia on a programme specifically to open up their memories and
increase socialisation (Ravn 2009). UCL Museums and Collections’ Heritage in
Hospitals project (with Oxford University Museums, the British Museum and
Reading Museum) took objects into hospitals to use as an ‘enrichment’ and wellbeing therapy with patients (Chatterjee, Vreeland, and Noble 2009). There is some
evidence that using museum objects in hospitals can also help with staff training and
communication skills, as a project involving medical students handling objects with
patients showed (Chatterjee and Noble 2009).
A related and more developed area of practice can give insight into how museums
could impact on health and well-being. Arts-in-health, providing music and art in
healthcare settings, is a more established area in healthcare organisations and the
evaluation of projects has established many benefits to patient health and well-being
(Staricoff 2004). The demand by health services, perhaps particularly the NHS (the
UK’s National Health Service), for a strong evidence-base for new interventions has
led to progress in evaluating arts-in-health initiatives (London Arts in Health Forum
2010; Manchester Metropolitan University 2007; North West Culture Observatory
2006). The Arts Council England and the UK Department of Health have produced
a Prospectus for Arts and Health (2007) that supports the contribution of arts to
major health issues. These findings are encouraging, but do not as yet include
museum programming. In fact, they often focus on what might be called ‘art
therapy’. They do, however, introduce the more intangible well-being outcomes of
the arts into an institutional culture still largely based on statistical evidence, and
they have gained ground in suggesting the value of the arts as a preventative activity
as well as a supplement to treatment.
The idea of community well-being in museum practice is much wider and might
include what policy makers variously call community cohesion, neighbourhood
renewal, civic engagement, local participation, safe spaces, and environmental
sustainability. It branches out from well-being changes in individuals, to the changes
made by a critical mass of these individuals in the community. Work that museums
currently do with their local communities, and hard-to-reach and excluded
audiences, might all be included in local governments’ ‘social well-being’ remit.
The museums’ role in regeneration, built heritage, tourism and retail can also relate
to ‘economic’ and ‘environmental’ well-being. These community issues, in turn,
are seen more and more to influence preventative mental health and individual
242 E. Ander et al.
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well-being. The potential contributions to community well-being are too numerous
to list and originate from nearly every museum, but they have mostly not been seen
or evaluated as such. The synergy between well-being and museums, culture,
communities and healthcare is conceptualised in Figure 1.
Objects in hospitals
Arts-in-health
Museum spaces
and services
WELL-BEING
Schools,
environment,
economy, elderly
care, children’s
services
Figure 1.
Outpatients
Community
healthcare
Well-being in (museum) practice.
Defining and measuring well-being
Museums deciding that they want to measure their contribution to well-being is just
the first step. Although the word ‘well-being’ appears to be ubiquitous, there are very
few definitions either in the academic literature, policy documents or everyday use,
and this provides the first difficulty when compiling evidence. Well-being is often
conflated with ‘health’, ‘quality of life’ and ‘happiness’. A literature review compiled
for the Scottish Government on cultural indicators of Quality Of Life (QOL) and
well-being admits that ‘QOL is a vague and difficult concept to define, widely used
but with little consistency . . . ‘‘well-being’’ is even more ambiguous, abstract and
nebulous a term . . . Put simply, an accepted, uniform definition of either term does
not exist’ (Galloway and Bell 2006, 2.67). Our own everyday, highly ambiguous use
of the word has been assumed by advertising and branding communications, and
taken in general to mean something healthy, warm and good for you, it is found on
herbal teas, yoga classes, gym adverts, water filters, cold remedies and lifestyle
magazines to name a few.
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Museum Management and Curatorship 243
This confusion, however, is mirrored in the academic and policy worlds.
International agencies, government departments and many other organisations
take it for granted that we (and they) know what well-being means. The World
Health Organisation (WHO) defines well-being as an element of health ‘Health is a
state of complete physical, mental and social well-being and not merely the absence
of disease or infirmity’ (WHO 1946), but does not offer a separate definition of wellbeing. A definition of mental health by the Health Education Authority (HEA), still
widely used, is ‘the emotional and spiritual resilience which allows us to enjoy life
and survive pain, disappointment and sadness. It is a positive sense of well-being and
an underlying belief in our own, and others’ dignity and worth’ (HEA 1997 cited in
CSIP 2007). This sense of resilience and flourishing, rather than just surviving, seems
an important connotation to well-being and is often implied in the use of the term.
Galloway and Bell (2006), researching for the Scottish Government, found that in
most academic research a definition was evaded or conflated with other concepts. In
academic disciplines we see the word used in economics, psychology and healthcare.
The Social Indicators movement and QOL research have also contributed.
Depending on one’s discipline, well-being could be seen as subjective or objective,
as individual or social, or as relative or absolute. Economists most often define wellbeing as happiness or life satisfaction, either generally or as satisfaction with a
number of life domains (Galloway and Bell 2006). They tend to look at it in terms of
population rather than individuals and connect it with wealth (utilitarianism). The
fact that ‘happiness’ levels have stayed flat while GDP has risen in the last century in
Western democracies (Bacon et al. 2010; Lane 2000; NEF 2009) suggests this
correlation is no longer valid. Economists are now looking at indices other than
GDP to reflect ‘happiness’.
A psychologist however, may or may not equate happiness with well-being.
Experimental psychologists and healthcare researchers have developed numerous
scales that attempt to quantify well-being in an individual. An example of a wellbeing scale is the Psychological General Well-being Scale (Dupuy 1984) that consists
of eighteen items within six dimensions (anxiety, depression, positive well-being, selfcontrol, vitality, general health). Respondents are required to rate statement items
(e.g., Has your daily life been full of things that were interesting to you?) on a scale of
one to six. The Affect Balance Scale (ABS) is another measure (Bradburn 1969)
which is described as ‘an indicator of happiness or general psychological well-being’
(Bowling 2005, 132). In this self-administered scale, well-being is conceptualised as
a balance between two independent dimensions: positive affect and negative affect.
The 10-item scale comprises five positive and five negative statements that correlate
with happiness, to which respondents are required to give a yes/no response. Bowling
(2005), in her book Measuring Health, references 79 scales that in some way look at
dimensions of well-being-these are merely the fully validated and documented ones.
However, these scales may neglect the individual’s own experience of well-being. In
standardising what psychological well-being is, there is little room for the voice of the
individual who may have a very different perspective on what makes them happy or
well. It also does not indicate why the individual has a certain well-being level.
The NEF, a think-tank directed at policy-makers, has undertaken useful work in
defining and measuring well-being, and defines well-being as ‘most usefully thought
of as the dynamic process that gives people a sense of how their lives are going,
through the interaction between their circumstances, activities and psychological
244 E. Ander et al.
resources or ‘‘mental capital’’’ (NEF 2009). A much broader and more subjective
definition, they suggest that in order to achieve well-being people need:
“
“
“
a sense of individual vitality
to undertake activities which are meaningful, engaging, and which make them feel
competent and autonomous
a stock of inner resources to help them cope when things go wrong and be resilient
to changes beyond their immediate control.
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It is also crucial that people feel a sense of relatedness to other people, so that in
addition to the personal, internally focused elements, people’s social experiences the
degree to which they have supportive relationships and a sense of connection with
others form a vital aspect of well-being. (NEF 2009)
For the European Social Survey (20062007), NEF developed their concept further
into a framework of well-being dimensions that included personal well-being
(emotional well-being, satisfying life, vitality, resilience, self-esteem and positive
functioning) and social well-being, including supportive relationships and trust and
belonging (NEF 2009).
The NEF is part of a new cohort of researchers who define well-being along two
or more dimensions, not just life satisfaction or emotion. In particular, there is
another essential component of well-being, something that the NEF (2004) term
‘personal development’. According to the NEF’s research into young people’s wellbeing in the city of Nottingham, at least two of these dimensions-life satisfaction and
personal development-can operate independently of each other, with some people
scoring much higher or lower on one dimension than the other. This ‘meaningfulness’ element has also been identified and developed by others, such as
Seligman (2002 cited in NEF 2004, 15) who sees ‘the good life’, or working towards
‘gratifications’ with some element of skill and challenge, as essential to well-being
alongside ‘the pleasant life’. Lane (2000) includes life satisfaction, human development and justice as elements of well-being-a ‘Trinity of Good’. Ryff (1989) has
validated her theory and scale of six dimensions of well-being including autonomy,
purpose in life and personal growth, all of which relate to the personal development
dimension of well-being, rather than just ‘feeling good’ or pleasure.
Another way of unravelling well-being is to look at its relationship to the term
‘health’. Health and well-being are used as interchangeable words in some disciplines
and yet remain separate and discrete in others, often partnered in the phrase ‘health
and well-being’. It could be questioned whether well-being and health are separate
phenomena. Health may seem more tangible, more bodily and more measurable:
Most existing clinical indicators reflect a ‘disease’ model. The ‘disease’ model is
a medical conception of pathological abnormality which is indicated by signs and
symptoms. (Bowling 2005, 1)
In contrast, well-being stands as a more positive, free-choice, and self-described
contentedness, with:
Dimensions of happiness, life satisfaction, morale, self-esteem and sense of coherence.
(Bowling 2005, 6)
The NEF cite growing research to relate their concept of well-being to health and
health to well-being (NEF 2004). A high level of well-being can improve health and
Museum Management and Curatorship 245
bad health is certainly a negative factor in well-being (Easterlin 2003 cited in NEF
2004, 18), but they are distinct phenomena. Further:
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There is strong evidence emerging that whilst the life satisfaction component of wellbeing is strongly related to mental health and depression, it is the personal development
dimension of well-being that seems to be linked more strongly to overall health,
longevity, resilience and ability to cope with adverse circumstances and ‘thrive’ in life.
(NEF 2004, 16)
In short, well-being can be seen as a protective phenomenon, and yet also enabling a
flourishing and a thriving individual.
One might set-up a dichotomy that has been used before with learning and
education: ‘the emphasis is no longer on ‘‘education’’, which implies a society-wide
system with common standards, but on ‘‘learning’’. Learning emphasises individual
learners, learning processes and learning outcomes’ (RCMG 2003, 8). Could it be said
perhaps that health and well-being take on similar roles? Health is based on
professionalised healthcare institutions, aiming for a health standard with targets
and systems. Well-being is more patient, or people-centred, and is about life processes
and resources and is not locked into a convoluted system-it is individualised. It was
said during the development process of the GLOs that ‘Learning in cultural
organisations is associated with creativity and innovative thinking and there can
also be seen the development of attitudes and values . . . within the traditional view of
learning these experiences would be ignored’ (RCMG 2003, 8).
It might also be said that well-being in cultural organisations is about phenomena
beyond physiological or mental changes, but associated with social, psychological,
emotional, spiritual and even cultural contributions to a sense of whole and
continuing well-being in the individual. However, while museology might be used to
gaining insight in such fuzzy research environments, healthcare services still demand
measurable and standardised phenomena, and governments and policy makers need
strong indicators of causality, needs satisfaction and generalisability to support wellbeing interventions. In addition, well-being can improve in the long term while being
uncomfortable to the individual in the short term. Museums may not always provide
a pleasant experience and unexpected attitude change, confrontation with controversy, the arousal of emotion and promoting new ways of acting and thinking,
although unsettling, may also contribute to well-being.
There are also several problems museums face in measuring their affect on wellbeing. First, there is little theory on which to base a framework. Second, the subtle,
individual and focused approach needed in the measurement of culture outcomes is
in conflict with the needs of policy and healthcare service evaluation:
Public policymakers world-wide require research that demonstrates causal relationships
between cultural participation and desired policy outcomes and for these to be singlecausal outcomes . . . . Another key issue for public policy makers is the need for research
whose results can be extrapolated or generalised to the population as a whole . . . the
majority of individual level studies of culture and sport and QOL do not allow this.
(Galloway and Bell 2006, 6.57)
Data that demonstrate cultural transformation or experience or, indeed, changes in
individual feelings of well-being, tend to be subtle, fugitive and qualitative they
have to be teased out of conversation and behaviour, rather than asked point-blank.
246 E. Ander et al.
As cultural programmes work with small numbers, so sample sizes tend to be small
and difficult for making predictions or generalising. People engage with culture in a
myriad of different ways, sitting alongside all other aspects of their lives such as
family, health, education, job, holidays, etc. The difficulty of isolating the affect of
culture in one’s life means that attributing the cause of change or transformation to
culture (causality) is also difficult. In gathering evidence for culture’s affect on wellbeing, a clash between validity and policy needs exists. Policy dictates what needs to
be measured and yet:
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When researchers impose the domains of life to be measured, they risk omitting
important aspects that may have greater relevance to that person or imposing aspects
that have little or no relevance. The results therefore may have little validity. (Day and
Jankey 1996 cited in Galloway and Bell 2006, 5.4)
Galloway and Bell, in concluding their literature review, suggest that QOL (and
well-being within it) may be:
Just not a fruitful subject for research: useful as an ‘organising concept’ but just too
complex to be ‘do-able’. Alternatively, these points might lead to the view that the
natural science research model, of which notions of ‘causality’ and ‘generalisability’ are
part, may not be the most useful for this type of research subject. (Galloway and Bell
2006, 8.4)
Well-being is the word of choice for new holistic conceptions of non-material wealththe great instrumental outcome to which all other policy outcomes relate and within
which they are networked with each other. Well-being is not sufficiently defined,
however, to suggest clear policy routes or measurement indicators. Searches for
definitions and measurement strategies are ongoing, now that the word has been
chosen and there seems no way back, but the search is a confusing labyrinth full of
dead ends and lost paths due to this core ambiguity. In its conception of human
benefit, well-being’s lack of restriction is a boon for museums that have often argued
for their contribution to human progress to be acknowledged. At the same time, this
makes it difficult to assess.
Towards a framework
At a practical level where might museums go from here? How can museum well-being
impacts be measured in order to persuade a healthcare or local authority that
museum participation will increase well-being? How can museums use the language
and paradigms of medical and/or policy-based evidence while staying ‘true’ to the
subtle and subjective well-being benefits that museums deliver? Perhaps once again
museums can learn from ‘learning’. This, too, seemed so diverse, free-choice and
individual that a ‘one-size-fits-all’ standard for what people should be achieving in
museums could not be built, as:
It would be inappropriate for museums, archives and libraries to set specific learning
outcomes for learners to achieve. They do not know the prior knowledge of their users
and so would be unable to make judgments about how much users had learnt. Users
themselves, however, are capable of making such judgments about their own learning.
(RCMG 2003, 7)
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Museum Management and Curatorship 247
The museum evaluators need to look at relative improvement in people’s well-being
under their own standards and in the dimensions they feel are important to them,
while attempting to isolate somewhat the role of culture or museums. A measure is
needed that is self-reporting and yet locks into a consistently-used framework of wellbeing dimensions and elements, so that it is universally understood, acknowledged
and compared. Could an evaluation framework for well-being be suggested, such as
the one used extensively to measure learning in UK museums-the GLOs? Qualitative
research would be needed to populate it with meaningful (to museum users, the
museum sector and policy makers), valid and relevant dimensions of well-being.
Measuring tools would be needed which can capture or quantify concepts and are
subtle enough to detect small and deep-running changes in well-being, and can also
feed into evidence that builds theory around the correlation between health/wellbeing and culture/museums.
Table 1 looks at some possible well-being outcomes identified in the literature
and suggests how museums might affect these. As discussed above, museums’ objects,
their activities, and their unique spatial and atmospheric conditions (Falk and
Dierking 1992; South West Museums, Libraries, Archives Council [SWMLAC] 2004)
will all contribute to well-being. The framework draws heavily on NEF’s Wellbeing
Indicators for the European Social Survey (20062007). It also draws on literature
around nursing and quality care for patients. Table 1 provides the potential basis of a
museum well-being outcomes framework, with the caveat that a final well-being
outcomes framework needs to be based on future research.
Museums also contribute to community well-being, which covers more social and
collective outcomes such as community cohesion, social capital, civil renewal,
community participation, sustainable environments and regeneration. These are
beyond the scope of this article and, in fact, have been comprehensively covered by
the GSOs, based as they are on much of the UK government’s policies, (including the
Home Office, Office of Deputy Prime Minister (now the Department for Communities and Local Government) and the Department for Culture, Media and Sport) on
sustainable communities. Social outcomes and well-being outcomes are related and
feed into each other, and are both major concerns of modern democratic
governments. The two should be viewed together, one looking at individual and
subjective development, the other at social and community scale development with
more scope for objective measures (often found in a change in a critical mass of
individuals).
In the framework, health and well-being are treated as separate outcomes and
both have several dimensions. It is believed that both are highly correlated, meaning
an increase in one, health or well-being, can often mean an increase in the other
(NEF 2004, 16). Most of the outcomes can be categorised as ‘instrumental’ benefits,
or benefits extrinsic to museum collections, but there is also a category of cultural
well-being that treats the ‘intrinsic’ value of collections and museums as an
important outcome towards individual well-being (Trustram 2010).
In order to develop a true framework, empirical and qualitative research would
need to refine the true meaning of these dimensions in cultural terms. There are
several such projects being undertaken currently, including UCL Museums and
Collection’s AHRC-funded Heritage in Hospitals (Award no AH/G000506/1). This
project looks at the well-being of hospital patients who have museum handling
sessions using a mixed quantitative and qualitative methodology. There is also work
Positive functioning (autonomy,
competence, engagement, meaning and
purpose)
Vitality
Well-being (resilient mental health, preventive and
protective factors) (CSIP 2007; NEF 2009; Ryff,
1989)
Personal well-being
Satisfying life
Sub-dimensions
Potential well-being outcomes framework with possible museum contributions.
Dimension of health or well-being
Table 1.
Museum participation that leads to fulfilment of
goals, drives, expectations and ambitions in life
including learning and skills as well as ‘the pleasant
life’.
A renewed interest and energy, provoked by inspiring
or motivating collections or working with other
people in a museum or community setting, e.g.,
motivated to volunteer twice a week and speak to
visitors or to join an events committee.
Improving mobility, confidence, new skills, physical
fitness, capacity for work and socialising through
participation in museums such as volunteering, social
events and clubs and learning programmes.
Activities and learning that encourage thinking for
oneself, joining a debate for example or using creative
processes.
Programming and displays that elicit profound
thoughts about one’s life direction and its meaning,
yet in a safe and accessible way.
For older people, encouraging their competence in
social situations, conversation, orientation and in
using their sense of touch in their hands through
object handling and group activities
Any individual learning and personal development
that goes on at a museum (see GLOs).
Possible museum contribution
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248 E. Ander et al.
Social well-being
Dimension of health or well-being
Table 1 (Continued )
Trust and belonging
Emotional well-being (positive feelings,
absence of negative feelings)
Resilience and self esteem (self-esteem,
optimism and resilience)
Sub-dimensions
Activities using objects that increase confidence or
capacity to do something new, such as a skill or new
knowledge thus increasing self-esteem. Activities and
objects that encourage reflection on own achievements
and qualities.
Activities that promote a feeling of cultural strength
and esteem through significant objects or objects that
tell inspirational stories.
Activities within a museum, including displays and
exhibitions on certain topics, as well as events and
participative activities, that encourage positive
emotions such as empathy, tolerance, happiness,
kindness, laughter. Activities and collections that
distract from or combat negative emotions calming
anxiety and bringing enjoyment and acceptance to
depressed, sad or angry people. Providing an
environment that is safe, calm and friendly.
Using collections to explore emotions and emotional
intelligence.
Working with people from your own and other
communities within a ‘neutral’ space, such as a
museum, on projects of mutual benefit. Museums can
help people explore their own and their communities’
qualities and characteristics through community
objects and create a feeling of belonging to a certain
community through interaction with people or their
cultural output.
Possible museum contribution
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Museum Management and Curatorship 249
Physical and sensory well-being
Cultural well-being
Dimension of health or well-being
Table 1 (Continued )
Body functioning well including good
nutrition, exercise and hygiene
Supportive relationships
Sub-dimensions
Bringing people together through the collections.
Participative activities, volunteering, events around
objects can all bring people together in new ways.
People can gain and strengthen contacts through
museums’ public role.
Museums can also provide a place for families and
friends to strengthen their bonds and the roles they
play, e.g., parents can encourage childrens’ curiosity
and informal learning and get to know their children
better in a family museum outing, grandparents can
interact with children and grandchildren by
contributing their stories and collections and working
on intergenerational projects.
Museums give an opportunity for people to
understand their place in the world and where they
come from through emotions, feelings and learning.
The knowledge that items of cultural importance are
kept for their own sake and benefit of future
generations is important to many people. The
intrinsic worth of things of beauty and meaning can
contribute to an underlying sense of human cultural
well-being.
Learning opportunities about healthy living and
anatomy, science and medicine.
Increasing multi-sensory and tactile senses and use of
touch through object handling.
Providing opportunities for exercise, e.g.,
conservation work at a heritage site, guided walks.
Possible museum contribution
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250 E. Ander et al.
Sub-dimensions
Possible museum contribution
Health (Chatterjee and Noble 2009; Chatterjee,
Vreeland, and Noble 2009; Irurita 1999; Matiti
and Trorey 2008; Radwin 2000; Redmond and
Sorrell 1999; Staricoff 2004; Williams and
Irurita 2004)
Recovery from or management of physical
Healing of wounds, towards normal body Objects and learning opportunities, provided at the
illness or injury
and cognitive function, fighting of infection healthcare setting or by the bedside, can contribute to
and disease, building strength
a positive mental outlook and cultural engagement
that improves rehabilitation, treatment and recovery
times and distracts from pain and discomfort. Using
objects to think about life and the world can bring
acceptance of new life after illness or accident.
Using objects in speech therapy, memory,
psychotherapy and physiotherapy for rehabilitation.
Recovery from mental illness
Reduction and/or control of anxiety,
Museums can provide a calm, inspiring and safe place
depression, etc., improvement in
in which to explore emotions, culture and past
schizophrenic or other symptoms
experiences with objects as stimulus. Collections and
displays can elicit creative expressions from those who
find it hard in other ways. Those expressions can then
promote communication and openness and then
acceptance and self-help.
Distraction, absorption and new perspectives can
help with anxiety or depressive symptoms.
Objects can be used with Alzheimer’s and other
elderly patients for memory and orientation work.
Museums can provide an inclusive and welcoming
atmosphere to those who are excluded from society as
a result of their illness.
Dimension of health or well-being
Table 1 (Continued )
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Museum Management and Curatorship 251
Improved hospital care or health care
Dimension of health or well-being
Table 1 (Continued )
Improved environments and social interaction both
provided through museum-based activities can
improve confidence, trust, dignity, and emotional
comfort.
Museum activities can increase communication,
analysis, bedside skills and observation skills vital in
staff and patients for good quality healthcare
(Chatterjee and Noble 2009). Museums can use
objects with staff and they can then use objects with
patients in their work.
Staff development
Possible museum contribution
Increased satisfaction with care
Better communication between healthcare
staff and patient
Increased trust, dignity, emotional comfort,
confidence, interpersonal interaction
Relaxing environment
Sub-dimensions
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252 E. Ander et al.
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Museum Management and Curatorship 253
by the North West Regional Museums Hub focusing on mental health. The Culture
and Wellbeing website run by the London Arts in Health Forum (2010) also cites
ongoing research in arts and health which can contribute to this evidence base.
The authors are part of the UCL Heritage in Hospitals research team and from
this work preliminary findings on well-being outcomes can be presented based on a
cohort of 210 patients who had museum handling sessions in a number of hospitals
and wards, including neurological rehabilitation, oncology, acute surgery and
psychiatry. The research uses three quantitative scales-a PANAS scale looking at
mood and emotion (Watson, Clark, and Tellegen, 1988), and two further Visual
Analogue Scales assessing general levels of well-being and of happiness, as well as
qualitative data through session recordings, observation and interviews. The results
in Table 2 define a range of well-being outcomes from this research and indicate the
multifarious impacts museum collections and object handling can have in the
healthcare setting.
Conclusion
This article suggests that museums do not have difficulty producing increased wellbeing and, indeed, already do so. It does not suggest a change in priorities or strategy
to engage with well-being. It only suggests that with the increased ubiquity of the
term ‘well-being’ in policy, that the sector needs to see its activity in that light and to
evaluate its programmes accordingly. Each government will be using well-being to
greater or lesser extent. In the UK, USA, Australia, New Zealand and Canada, it is a
common appearance and with the current funding climate, it seems more important
to grasp and demonstrate the contribution that museums can make.
The well-being agenda, however, presents difficulties with its ambiguity and
amorphousness but, as with learning, it needs to be used by museums to their
advantage. The heritage sector must ensure that they make sense of the concept and its
dimensions, and know that it taps into others’ construction of it and understand what
museums add. The sector should develop a common framework as soon as possible,
which goes beyond the GSOs, to take advantage of this policy agenda. Culture and
heritage do influence well-being, but not in a way that fits with the traditional medical
understanding of the body and mind. It needs new disciplinary approaches, such as
psychoneuroimmunology (bringing social and cultural experience into explanations of
the immune system see Kirmayer 2003; Napier 2003; Watkins 1997), or ‘museopathy’
(Chatterjee, Vreeland, and Noble 2009), to start to challenge the idea that improving
well-being needs to be objective and enumerated to be worthwhile.
The relationship between an individual and his or her environment may be far more
reciprocal and dynamic than our Cartesian notions of the self would permit. Any simple
simulation of a ‘cultural factor’ in a controlled experimental setting can, then, provide a
possible or hypothetical response, but not a paradigmatic one; for ‘experience’ will
always creatively transcend the uncreative certitude of the experimental method. And
any notion of a self that defines a person exclusive of his or her social meaning will,
likewise, lack the dynamism by which an individual shapes and is shaped by experience.
(Napier 2003, 278)
Culture needs to find its place in the well-being jigsaw puzzle. Museums can learn
from the GLOs and the journey ‘museum learning’ has taken, which could not use
254 E. Ander et al.
Table 2. Preliminary well-being outcomes in the Heritage in Hospitals museum handling
sessions.
Well-being outcome
How the handling sessions affect
the outcome
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Personal well-being: The sessions increase positive
moods in patients and possibly
Emotional wellmore importantly reduce negative
being
feelings such as pain, anxiety,
boredom and depression
particularly in the oncology wards.
Personal well-being: Some patients who have sensory or
motor impairment, for example
Positive
stroke patients who have the loss of
functioning
feeling or use in one hand and arm,
can use the exploration of objects as
an inspiring way to practice using
their hands. Different textures and
objects inviting holding, turning
and touching can be motivating to
re-learn using touch sensation
again. Learning to participate in a
group during group sessions,
particularly in psychiatric wards.
Personal well-being: Object handling provides
Vitality
motivation to sit up in bed, interact
with someone new, retrieve
memories and knowledge, use the
sense of touch, gradually learn
something new and tell visitors
about their session. All this can be
seen as increased vitality, especially
as being bed-bound in a hospital
offers little stimulation to exhibit
vitality, potentially for many days
or weeks.
Talking together about something
Social well-being:
entirely new and different is
Supportive
refreshing and motivating for
relationships
patient and visitors. The patients’
conversation during a subsequent
visit dwells less on illness and more
on cultural topics. Because the
sessions are one-to-one they are
also very flexible in responding to
patients’ different needs.
How it is measured
Through the PANAS measure
which looks at positive and
negative affect (emotion) before
and after the session and through
the qualitative session recordings
where people talk about their
emotional state and exhibit it
through what they say and how
they interact.
Over a longer time scale,
observation and session
recordings can be used to assess
improvement in patients.
However, causality will be difficult
to attribute as patients will be
receiving a number of therapies
concurrently. Talking to their
main healthcare carers, in
qualitative interviews might
ascertain progress gained from
museum sessions.
Qualitative data can detect a rise
in vital behaviour and interaction.
The PANAS mood scale also
includes moods such as ‘active’,
‘alert’ ‘inspired’ and ‘excited’,
which can be interpreted as signs
of vitality.
The session recordings capture
some of this when patients talk
about their visitors and when they
capture visitors’ contributions.
Post-session interviews also
capture some of subsequent visit
interaction.
Museum Management and Curatorship 255
Table 2 (Continued )
Well-being outcome
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Recovery from
physical illness
Improved hospital
care
How the handling sessions affect
the outcome
In keeping patients’ emotions
positive and interesting and
inspiring them, recovery and
distraction from pain during
recovery can be achieved. Both
emotional and cultural (and
perhaps spiritual) improvements
can also influence the patients’
subjective assessment of their
recovery and hence help them to
cope with physical changes and
processes.
Handling sessions provide
personalised, interesting, uplifting
and cultural care in a way that
normal hospital care neglects. In
that sense it provides for the
broader needs of patients while in
hospital and hence a more rounded
and satisfying care. Talking to
patients through handling sessions
can also improve communication
and conversation skills so that
patients are more able to
communicate with healthcare
professionals.
How it is measured
The emotions and mental outlook
that contributes to physical
recovery can be seen in mood
adjectives and session recordings.
Patients’ own assessment of their
recovery is difficult to attribute to
museum intervention alone.
Accessing and interpreting
medical notes is difficult but
interviewing medical staff to gain
qualitative data is possible.
Interviewing healthcare
professionals in the hospital to see
if they notice an improvement in
patients who have had handling
sessions. Qualitative data from
patients on how the museum
intervention contributed to their
hospital care.
standard or traditional assessment data either. Teachers had to shift their thinking to
include more ‘outside of the classroom’ learning, even though they have traditionally
dealt mostly in non-free-choice learning. A similar paradigmatic change may be
required in the health sector, although it is increasingly recognising the
benefits of prevention, rather than cure, and the role of the third sector and local
authorities. That is why bringing museums into healthcare environments is
important, so that the organisations and their staff themselves have contact with
culture. The challenge then is to define a contribution to well-being, but to define it
in a way that ensures that the unique and idiosyncratic affect of museums is credited,
and then to measure with tools that are sensitive enough to show the heritage sector’s
contribution, including qualitative (patient or people centred) words and meanings.
Then, bring this to the attention of managers, medical professionals and policy
makers in a way they not only understand, but that also broadens their concept
of care.
If Matarasso was right when he concluded that ‘Rather than the cherry on the
policy cake to which they are so often compared, the arts should be seen as the yeast
without which nothing will rise’ (Matarasso 1997), then the arts are vital to achieving
government policy goals and yet are invisible. Some sophisticated instruments are
256 E. Ander et al.
needed to measure this, but to measure not only the size and volume of the cake, but
also the flavour-taking into account that different people like different cakes.
Notes on contributors
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Erica Ander is Research Assistant on the University College London (UCL) Heritage in
Hospitals research project. She also works as a museum and heritage consultant specialising in
visitor studies and audience research. Her research interests include qualitative methodologies
to capture cultural outcomes, health and well-being issues in the museum sector, measuring the
impact of strategic funding in museums and archives, and the development of the museum and
archive profession.
Linda Thomson is a Research Associate on the UCL Heritage in Hospitals project. Since
obtaining her PhD in Psychology in 2001, Linda has worked as a lecturer and researcher
specialising in memory and learning, and research methods. She has a particular interest in the
part played by the senses of vision and touch in enhancing health and well-being. Prior to her
psychology career, Linda was employed as a Designer for BBC Television and as a Production
Director for an independent production company.
Guy Noble, Arts Curator at UCL Hospitals and Chair of London Arts and Health Forum,
has worked in ‘Arts in Health’ since 1998. He was co-instigator of the research project Heritage
in Hospitals, a project exploring the potential of museum object handling as an enrichment
activity for patients, and has published on the subject. He has extensive experience in hospital
arts programming and is interested in the role that cultural organisations can play in health.
Anne Lanceley is a Senior Lecturer and Nurse Specialist, Institute for Women’s Health,
University College London. Her clinical practice and research interests focus on women
with gynaecologic cancers. She combines a clinical role supporting women with cancer with
running a clinically-grounded research programme in the areas of symptom management,
recovery after treatment and risk reduction for survivors. Key components are potential
bio-behavioural interventions and improved psychological well-being. Anne oversees Heritage
in Hospitals in Gynaecological Oncology at University College Hospital.
Usha Menon is Professor of Gynaecological Cancer and Head of the Gynaecological Cancer
Research Centre at the UCL Institute for Women’s Health and Consultant Gynaecologist,
UCLH NHS Trust, London. She is Principal Investigator on the UK ovarian cancer screening
trials and on studies exploring ovarian cancer symptoms. Other research includes genetic and
environmental risk factors and novel biomarkers in ovarian cancer. The research has attracted
peer reviewed funding of over £25 million. Usha is co-investigator on the Heritage in Hospitals
project.
Helen Chatterjee is Deputy Director of Museums and Collections and Senior Lecturer in
Biological Sciences, both at University College London. Her research interests include touch
and value of object handling in health and well-being, and its pedagogical value in education.
She edited ‘Touch in Museums: Policy and Practice in Object Handling’ and is Principal
Investigator on the AHRC-funded Heritage in Hospitals. Her current research focuses on the
role of museum object handling as a therapeutic activity in healthcare.
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