Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=rahe20 Download by: [Dr Judy Rollins] Date: 31 August 2016, At: 05:39 Arts & Health An International Journal for Research, Policy and Practice ISSN: 1753-3015 (Print) 1753-3023 (Online) Journal homepage: http://www.tandfonline.com/loi/rahe20 The Vintage Photograph Project Judy Rollins & Kathleen E. Wallace To cite this article: Judy Rollins & Kathleen E. Wallace (2016): The Vintage Photograph Project, Arts & Health, DOI: 10.1080/17533015.2016.1223706 To link to this article: http://dx.doi.org/10.1080/17533015.2016.1223706 Published online: 30 Aug 2016. Submit your article to this journal View related articles View Crossmark data
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Full Terms & Conditions of access and use can be found athttp://www.tandfonline.com/action/journalInformation?journalCode=rahe20
Arts & HeAltH, 2016http://dx.doi.org/10.1080/17533015.2016.1223706
The Vintage Photograph Project
Judy Rollinsa,b and Kathleen E. Wallacec
arollins & Associates, Washington, DC, UsA; bFamily Medicine and Pediatric, Georgetown University school of Medicine, Washington, DC, UsA; cChild life, education, and Arts, Medstar Georgetown Hospital, Washington, DC, UsA
ABSTRACTBackground: Placing artwork in hospitals and creating art have been shown to help children cope with the stress of hospitalization. The Vintage Photograph Project combined passive and active arts engagement for an intervention that explored hospitalized children’s interest in and responses to restored vintage photographs. Methods: This descriptive study included a convenience sample of 20 hospitalized children, ages 5–18 in the United States. Drawing accompanied a one-time interview. Results: The photographs were of interest to all participants. Subject matter and feelings drove the child’s choice of favorite photograph. Responses to the photographs were incorporated within five themes: (1) exploring the unfamiliar, (2) seeking the familiar, (3) seeing something cute, (4) finding something funny and (5) liking what they saw. The act of drawing promoted conversation and social interaction; generated humor and stories of family, friends and pets; and resulted in artwork for an interesting hospital art exhibition. Conclusions: Findings suggest that restored vintage photographs are a subject of interest to hospitalized children and are worthy of consideration for comparison studies to determine their potential as positive distractors for hospitalized children. Study methods that incorporated vintage photographs provided an enjoyable and therapeutic intervention for children and their families.
Introduction
Hospitalization is known to be stressful for anyone, but is especially so for the developing child. The environment seethes with the unfamiliar. In addition to the sea of unfamiliar faces, there are other strange sights, sounds, smells and tastes – any of which can be frightening if the child does not know what they are (Rollins, 2016). Findings from a study of 4–6-year-old children revealed that more than 90% of the children were afraid of at least one aspect of being in a hospital (Salmela, Salantera, & Aronen, 2009). Although most fears involved nursing interventions, being a patient and fears related to the child’s developmental age, children reported fears caused by the unfamiliar environment. The unfamiliar environment also was among the fears identified in a study with hospitalized school-agers, children ages 7–14 years (Coyne, 2006).
one of the means proposed to support dealing with stress in health care environments is access to positive distractions (Ulrich, 1991). Ulrich defines a positive distraction as “an environmental feature or element that elicits positive feelings, holds attention and interest without taxing or stressing the individual, and therefore may block or reduce worrisome thoughts” (p. 102).
What about artwork’s effectiveness as a positive distraction for hospitalized children? Research has shown tremendous potential for favorable outcomes of using images as positive distractors in pediatric settings. Reporting on their study of 158 children in clinic waiting areas (Pati & nanda, 2011) found that the introduction of distraction conditions via five different images in a continuous slide show shown on a single plasma screen was associated with more calm behavior and less fine and gross movement in children, which suggests significant calm-ing effects associated with the distraction conditions. Research also tells us that pediatric inpa-tients have significant differences in art preferences across different age groups and cautions that “one should be careful before using the ‘one-size-fits-all’ approach” (nanda, Chanaud, Brown, Hart, & Hathorn, 2009, p. 46). Thus, a variety of types artwork should be explored.
Creating art has many benefits for hospitalized children (Rollins, 2016). Engaging in arts experiences can provide distraction from pain and discomfort. Such experiences can empower children by placing them in active roles as “doers” instead of “receivers.” Children have opportunities to explore safe methods of emotional expression, to make the most of their present abilities, to engage in something familiar and enjoyable and to learn and grow in many significant ways. Further, according to Archibald, Scott, and Harling (2014), engaging in visual arts activities can facilitate or reduce specific child attributes (e.g. self-efficacy, anx-iety) and facilitate understanding through communication or assessment.
Arts-based interventions that include both passive and active art experiences have been found to help children gain a greater sense of accomplishment, self-worth and control during hospitalization (lifespan, 2016). We were curious; would hospitalized children enjoy an arts intervention that combined viewing an unusual type of photograph followed up by creating their own art? Within a realist theoretical framework for our study, our first step was merely to determine if restored vintage photographs were of interest to hospitalized children. From there, we would provide children an opportunity to create art that would contribute an interesting component to a vintage photograph art exhibition.
This study had the following aims:
(1) To describe hospitalized children’s responses to a selection of restored vintage photographs.
(2) To describe the nature of the children’s interest with the images.(3) To develop an arts-based therapeutic intervention for hospitalized children.
Vintage photographs
A vintage photograph itself is not just of a certain age but rather refers visually to that age, often in either an iconic or cliché sort of way. Vintage photographs point to its era through details and recognizable symbols in the image. They typically exhibit something universally recognizable as being from their era (Goldsmith, 2010). The most common categories of vintage photographs include portraits, transportation, architecture, landscape, military, children, animals, historical memorabilia, entertainment memorabilia and art (Your guide to
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buying vintage photographs, 2013). Although some vintage photographs are black and white, often we associate vintage photographs with sepia tones. Regarding sepia, Flannery (2012) offers the following observations:
Unique among all colors, sepia-toned photography instantly evokes the past and envelopes the viewer in the warmth and mystery of historical dimension. The medium is an easily understood visual key to a bygone time – one that perhaps even imbues the viewer with reassurance of continuity and conviction that life goes on – vital dimensions of mental, physical and spiritual healing. (p. 5)
Methods
Design
This descriptive study featured qualitative methods including interview accompanied by drawing. The authors’ university’s Institutional Review Board approved the study.
Sample
The convenience sample consisted of 20 participants, 5–18 years of age, hospitalized at an academic medical center in the mid-Atlantic United States. Children were recruited from staff recommendations from the pediatric units’ inpatient census lists. Selected demographic and diagnostic characteristics can be found in Table 1.
There were more girls than boys, and 6–8-year-olds and 12–14-year-olds were the age ranges most represented. The majority of children were either white or African-American. Regarding diagnostic characteristics, over a third (n = 7) of the children were hospitalized for liver and/or gastrointestinal transplants, which require a lengthy hospital stay, most occurring under isolation protocol to protect a compromised immune system status. Two
Table 1. Demographic and diagnostic characteristics of participants N = 20.
Variable n (%)
Age
6–8 years 6 (30) 9–11 years 5 (25) 12–14 years 6 (30) 15–17 years 3 (15)
Gender
Boys 7 (35) Girls 13 (65)
ethnicity
White 8 (40) African-American 7 (35) Hispanic 3 (15) Chinese 1 (5) Arabic 1 (5)
Diagnosis
transplant 7 (35) leukemia 2 (10) Asthma 2 (10) Other medical, chronic 3 (15) Other medical, acute 5 (25) Other surgical 1 (5)
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children had a diagnosis of leukemia, two children were admitted for asthma and each of the following diagnoses was represented by one child: seizures, appendicitis, volvulus (a twisting of the intestine), Crohn’s disease, lupus, diabetes, urinary tract infection, cellulitis and Pediatric Autoimmune neuropsychiatric Disorders Associated with Streptococcal Infections (PAnDA).
Instruments
Two instruments were used to gather data. These included interview and drawing.
InterviewThe investigators used an interview guide with the following questions:
(1) What strikes you most about these photos? (What do you think of these photos?)(2) Which do you like best?(3) Why is that?(4) Are there any that “turn you off?”(5) Why would that be, I wonder?(6) What does your favorite photo remind you of?(7) What do you think is going on?(8) What do you think happened right before?(9) What do you think might happen next?(10) Do you think there should be photographs like these in hospitals?
DrawingDuring the interview, children were asked to complete a drawing about their favorite pho-tograph. This method is in keeping with the illuminative drawing technique. With this tech-nique, the researcher does not impose analysis of the child’s work, but instead encourages the child to use the artwork as a communication tool (Spouse, 2000). Children use this type of drawing as a means of direct expression and/or as a focal point from which conversation can flow. This second way Rollins (2005) calls the “campfire effect,” the result of an activity or experience that provides a focal point shared by the individuals involved that serves to increase conversation in both quality and quantity. Using drawing while interviewing has been found to increase the amount and richness of children’s interview data (Driessnack, 2005; Rollins, 2005).
Additionally, the literature on stress provides rationale for using drawing in The Vintage Photograph Project intervention. Ryan-Wenger (1992) describes 15 categories of strategies children can use to cope with stress in health care settings. of these, the use of at least five – “behavioral distraction,” “cognitive distraction,” “emotional expression,” “self-controlling activities” and “social support” – can be fostered by engaging in drawing, painting and other arts activities.
Procedure
The investigators reviewed with the child and parent(s) an easy-to-read brochure that explained the study and other study materials. Upon parental consent and child assent,
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children were shown eight restored vintage photographs. The first author and a pediatric oncologist selected the photos using Ulrich’s recommendations as a guide:
The most effective positive distractions are mainly elements that have been important to humans throughout millions of years of evolution: (1) happy, laughing, or caring faces; (2) animals; and (3) nature elements such as trees, plants, and water. (Ulrich, 1991, p. 102)
Another piece of the selection criteria was diversity in activity. Four of the images feature children engaged in activity; in the other four the people are more passive. Diversity in ethnicity in the subjects was also a consideration, with both African-American children and white children represented, as well as one group of Asian children.
The 11″ × 14″ photographs, which were donated to the hospital, were Epson Premium semi-matte photo paper prints face-mounted to 1/8th clear acrylic and backed with 1/8th Komatex. Seven of the photographs were black and white and one (#4) was sepia-toned. A .75″ faux wood border was added to each print, making the final panel size 13.5″ × 15.5.”
The investigator asked the interview guide questions and recorded answers on the guide. Children were given paper and colored markers and asked to draw a picture and tell a story in response to their favorite photograph. no time limit was set to complete the drawing. Times ranged from 30 to 90 min, with most children finishing in about 45 min.
At the completion of the drawing, the investigator asked, “Would you like to tell me about your picture? (Would you like to tell me a story about your picture?)” Answers were recorded on the interview guide. Afterward, the investigator thanked the child and expressed antic-ipation and excitement about seeing the child’s drawing at the upcoming exhibition.
Parents or other family members were often present during the interview/drawing activity and frequently contributed to the conversation. However, they were not interviewed and their comments were not recorded as part of data collection.
The collected works then became the subjects for a display in the hospital’s Children’s Art Gallery, together with children’s brief narratives attached to their images. The gallery installation thus included the restored vintage photographs and the children’s own artwork and accompanying narrative, side-by-side.
Data analysis
The researchers reviewed interview notes and analyzed the answers to the general questions with demographic data for preference data (e.g. the most popular photograph, the least popular photograph). The reasoning to support children’s choices was analyzed for themes. Answers to questions about the child’s specific chosen photo were written in a narrative format. The stories were analyzed for themes. When there was disagreement, the researchers discussed the issue until achieving consensus. Additionally, the child’s choice of favorite photograph was analyzed according to the child’s gender, age and nature of disease (life threatening or non-life threatening).
Results
The majority of children, and in some cases their parents, said they had never before seen a vintage photograph. The photographs generated lively conversation between children, family members, visitors and staff, with comments and questions about the people, animals and activities presented. In some instances, when children were recalling memories, parents
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provided additional details, which served to enrich the children’s narrative and in some cases their drawings.
All the children seemed to enjoy creating their art, and conversation flowed easily. We thought that the older children might be more reluctant to draw, but that wasn’t the case. If any factor seemed to affect children’s eagerness to draw, we would say it would be fatigue. Children with higher energy levels drew more details. The process of combining drawing with the interviews ignited the “campfire effect,” increasing interview data in both quantity and quality for all participants. For reference, three children’s drawings are included with their respective responses.
Favorite photograph
The participants spent significant time looking over the eight photographs to choose their favorites. See Figure 1 for their selections. The most popular photograph was of the boys with the dogs wearing sunglasses and hitched to a wagon (#1). Following closely behind was the photograph of the girl with the bear cubs (#2). of the eight photographs, only one – the children at the temple (#8) – was not chosen by any of the participants.
Primary reasons children offered for selecting a particular photograph was the subject of the photograph (i.e. liking the activity, liking animals, finding the subject interesting or funny), and/or that looking at the photograph made them laugh or feel happy. Children were also attracted to certain photographs because they said the photograph reminded them of home (i.e. pets and/or family members). Table 2 illustrates a summary of the children’s rationale by favorite photo choice. There were four photographs that a few children said they didn’t like. Table 3 presents these findings and the comments offered as rationale.
Twice as many boys (n = 4) selected #1 Dogs and children than did girls (n = 2). More girls (n = 4) than boys (n = 1) selected #2 Girl with bears. only girls chose #3 Playing golf, #4 Goose pulling carriage and #6 Brushing teeth. one girl and one boy selected #5 Man and dogs on rails.
Age wise, among the six 6- to 8-year-olds, half chose #2 Girl with bears; 60% of the five 9- to 11-year-olds chose #1 Dogs and children. The 12- to 14-year-olds choices were more distributed, with two children choosing #4 Goose pulling carriage, and one each selecting #1 Dogs with children, #2 Girl with bears, #3 Playing golf and #6 Brushing teeth. Among the three 15- to 17-year-olds, two chose #2 Girl with bears and one chose #1 Dogs and children.
Regarding the nature of disease, children pre- or post-transplant (n = 7) and children with leukemia (n = 2) were considered in the category of life threatening. A least one transplant patient was represented in all but one of the seven photos selected; the older of the two girls with leukemia chose the second most popular photo, # 2 Girl with bears and the younger one chose #3 Playing golf.
Responses to photographs
The children’s responses to the photographs were incorporated within six themes: (1) explor-ing the unfamiliar, (2) seeking the familiar, (3) seeing something cute, (4) finding something funny and (5) liking what they saw.
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Image Age Gender Diagnosis
#1 Dogs and children
11
10
9
16
12
15
M
F
M
M
F
M
Appendicitis
PANDA
Asthma
Seizures
Transplant
Lupus
I like animals, dogs.
The dogs are wearing sunglasses and smoking.
It makes me feel happy.
The dogs grabbed my attention. They are cool and collected.
#2 Girl with bears
8
15
8
13
8
F
F
M
F
F
Transplant
Leukemia
Cellulitis of arm
Asthma
They are cute and make me happy.
I like bears and baby animals.
Reminds me of my friend
They are cute.
#3 Playing golf
13
6
7
F
F
F
Transplant
UTI
Leukemia
It reminds me of playing with my sisters.
I like the game they are playing.
It reminds me of my cousins who play hockey.
Figure 1. Photo choice, demographics, diagnosis and rationale.
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#4 Goose pulling carriage
13
12
F
F
Diabetes
Volvulus
The farmer put the baby in the cart and is taking the baby, dog, and duck to the sea and valley.
I like the chicken.
#5 Man and dogs on rails
8
10
F
M
Transplant
Transplant I live around a lot of animals.
#6 Brushing teeth
12 F Transplant Kids look like they are friends and having fun.
Figure 1. (Continued).
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Exploring the unfamiliarSome children commented on the unfamiliarity of the photos, how they photos differ from what is commonly seen today. of note, the majority of the children did not seem to notice or comment on the one sepia-toned photograph (#4 Goose pulling carriage) being different from the others until the researcher pointed it out to them. John, age 16 commented, “These are weird; I haven’t seen anything like this before.” Five children pointed out that the scenes were old and unlike what we see today. They discussed clothing, transportation, and other differences:
They need color. The people look poor. Their dress is different. They’re in a wagon. (Sally, age 12)
A subtheme of unfamiliar was confusion. Grace, age 12 said that she didn’t understand the photos. Two children mistook the game of golf for hockey, and the goose was referred to by one child as a duck and by another as a chicken. one child said that the children brushing their teeth were eating. A second subtheme was interesting. Four participants specifically used the word in response to the request for their opinion of the photographs. For example:
They’re old, an interesting choice. Very interesting to see dogs dressed up. (Charles, age 11)
#7 Baseball
11 M Transplant I like baseball.
#8 Children at temple
No one selected this image.
Figure 1. (Continued).
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Seeking the familiarSome of the images brought forth memories of home, family and familiar activities. For example:
I like the golf picture. They are playing outside. It reminds me of playing with my sisters. (Molly, age 13)
My favorite is the one with all of the dogs and the man. The picture reminds me of dogs I see at home. I live around a lot of animals. The dogs are riding on the railroad. I think right before the picture there was a war. now the dogs are homeless. (Joey, age 10)
I like the hockey picture. They called their friends to play hockey. It reminds me of my cousins who play hockey (Ellen, age 7)
I like the one with the dogs and the kids because I like animals. The picture reminds me of my dog. It looks like they are having fun with their dogs. In my picture there is one big dog and one little dog. Hospitals should have a pet room with dogs and other animals. Doctors and parents can feed them. (Richard, age 11)
My favorite is the one with the kids and dogs and the dogs are smoking. The kids are going to a fort in the wilderness and the dogs are taking them there. I think the dogs didn’t like it, getting dressed up, and wouldn’t go anywhere unless they saw a deer. The photo reminds me of my dogs. We dress them up and take pictures of them. At Christmas we dress them up as reindeer and hook them up to a wagon. (Elizabeth, age 10)
Table 3. Disliked images.
Image n Rationale#4 (Goose pulling carriage) 2 (1) Weird
(2) Just don’t like it
#5 (Man and dogs on rail) 2 (1) Doesn’t look entertaining(2) Just don’t like it
#6 (Brushing teeth) 2 (1) Just don’t like it(2) Just don’t like it
#8 (Children at temple) 2 (1) Just don’t like it(2) Just don’t like it
Table 2. Frequency of use of primary rationale for selection of favorite photograph by number of children citing.
#1 Dogs & children
#2 Girl & cubs
#3 Golf
#4 Goose
#5 Man & dogs
#6 Teeth
#7 Baseball
Total n (%)
subject
like the activity 2 2 1 1 6 (30)like animals 1 5 1 7 (35)Find it interesting 2 2 4 (20)Find it funny 5 2 2 1 10 (50)Makes me happy 1 1 1 3 (15)
reminder of home
reminds me of (my or family members) dog(s)
4 2 6 (30)
reminds me of my family
3 2 2 1 8 (40)
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Seeing something cuteAlthough only three participants mentioned cute, because all three used the exact descriptor and all were in reference to the bear cubs, we thought it interesting and perhaps worth mentioning. A mother noted differences in attitudes toward protecting children in earlier times and said it would be unlikely to be able to recreate the girl and bear cubs scene today. Her daughter agreed. Regarding cute:
I like the one with the bears because they are cute and like the little girl. The bears like the girl because she is cute. Right before the girl was sad because the bears knocked over the bowl. now the girl plays with the bears. The picture makes me feel happy. (Amanda, age 8)
I like the photo of the girl and the bears. I think they’re cute. I think the cubs were running to the girl and maybe they were hungry because there is a bowl in the picture. It reminds me of the lake at Deep Creek. There are lots of bear pictures in the house we stay in. (Maria, age 8) (See Figure 2)
Finding something funnyTen children used the word funny, specifically talking about items such as the way the dogs were dressed or the notion of a goose pulling a carriage. The amusing images (e.g. dogs dressed up) generated laughter and some very funny stories:
I like the dogs and the kids on the cart with the dog smoking. It’s funny. The boys are just having fun. They probably had trouble getting stuff on the dogs. Mischievous boys. It reminds me a little of my dog. once our dog Greta got on the roof of our house in Vermont. She had crawled out the window on the second floor. My dad heard her whining and brought her in. We put headbands on Greta. (George, age 9) (See Figure 3)
My favorite is the dogs and kids on the cart. The dogs are wearing sunglasses and are smoking. The kids put the dogs where cows or horses would be and dressed them up to be funny. They were probably really bored before. The photo reminds me of when all of us cousins would get
Figure 2. Maria, age 8.
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together and put things on their dog at our grandparents’ house. In my drawing a little kid is sitting next to the dog, kneeling and relaxing with the smoking dog. (Eddie, age 16)
I like the photo with the baby buggy and chicken because I like the chicken. The picture reminds me of chickens and it’s funny. The chicken is pulling a baby. Maybe they went shop-ping. Afterwards maybe they ate the chicken. (Sally, age 12)
Liking what they sawAll 20 participants expressed a favorable opinion about using this type of image in the hospital. “They are cool,” said one participant. He continued:
My favorite is the one where the dogs are dressed up. The dogs grabbed my attention because they look cool and collected. The photo reminds me of adventure. It looks like some kids were playing around, stopped to take a break, and took a picture. They might find something that brings their friendship together. (Alexander, age 15) (See Figure 4)
I like the baseball picture because I like baseball. (Charles, age 11)
Even 12-year-old Grace who said she didn’t understand the photographs said she would like to see this type of art in the hospital because “They cheer me up.” Happiness was a subtheme:
I like the picture of the dogs with the glasses. The photo makes me feel happy. It looks like they are going to a baseball game. Afterwards, the boys will be dressed up like the dogs. (Sue, age 12)
My favorite is of the kids playing. They are outside eating something. The kids all look like they are friends and having fun. It reminds me of something that my cousins and friends and I would do together. I drew a smiling face because the picture made me happy, cheered me up. (Grace, age 12)
Figure 3. Geroge, age 9.
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The Vintage Photograph Project exhibition
The project culminated in an exhibition in the hospital’s Children’s Art Gallery, a space that contains both permanent and temporary exhibits. Children’s drawings and accompanying narratives were hung alongside their respective restored vintage photographs. Future plans include sending the photographs to additional hospitals for other children to become a part of The Vintage Photograph Project.
Discussion
The children in the study were aware that these photographs from bygone times were outside their frame of reference. nonetheless, despite unfamiliar black and white and sepia image presentation, children were able to identify with the subjects and/or activity depicted. Without the distraction of color, composition becomes more pronounced and thus more easily comprehended (Ricca, 2012). Further, the use of figurative artwork, as opposed to comics or cartoons, offered reality, which may have permitted the children to more easily identify with the subject.
Figure 4. Alexander, age 15.
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Regarding favorite photo choices, in reviewing the activity being depicted in each photo, it was noted that half of the photos showed children actively engaged in doing something (#3 Playing golf, #6 Brushing teeth, #7 Playing baseball and #8 Playing a game at a temple). no one selected #8, perhaps because the temple scene and game the children were playing were a bit too unfamiliar. However, five participants chose one of the other three. These three images depicted activities familiar to the children (e.g. “I like baseball.” “It reminds me playing with my sisters.”) or the children perceived them as enjoyable (e.g. “I like the game they are playing.” “The kids look like they are friends and having fun.”). In the other four photos, the people were less active, and in one of these photos (#5 Man and dogs on rails), there were no children, only a man and animals. of interest: of the eight photographs, 75% of the participants selected these more passive scenes as their favorites, using terms such as “relaxed” and “chilled out,” perhaps being drawn to “quieter” images in the fast paced hospital setting.
Five themes emerged from the data. First, the vintage photographs with scenes from long ago presented images to children for exploring the unfamiliar. They commented on differences (e.g. “Their dress is different.” “Very interesting to see dogs dressed up.”) other children were confused and asked questions. When one child asked why children were stand-ing around outside brushing their teeth, she and the researcher did a quick Internet search and discovered that in the 1920s, children were given toothbrushes at school and taught to brush their teeth. The incongruity theory of curiosity proposes that our curiosity is raised when we encounter something that does not fit our normal worldview (Berns, 2005). When things do not fit, we tend to try to figure it out. We know that curiosity can be aroused by a desire for knowledge (Rollins, 2011). Thus, the unfamiliar characteristics captured children’s attention, a primary factor in distraction.
Some children seemed to be seeking the familiar, perhaps seeking the comfort of the familiar. Certain photographs reminded children of stories of family and friends (e.g. “It reminds me of the lake at Deep Creek,” where her family has a vacation home). often parents or grandparents were present and elaborated on these stories, for example, a child’s mother filled in details of the story of their dog on the roof. Stories about family triumphs and failures provide powerful models for children. They come to understand who they are in the world through both their individual experience and through family stories that provide a sense of identity through historical time (Fivush, Bohanek, & Duke, 2008). Children learn that when faced with a challenge, families can just add a new chapter to their life story that shows them overcoming the hardship, a positive thought when experiencing the stressors of hospitali-zation. Family stories also help children by evoking pride, personal history, a sense of con-nectedness and feelings of being special, even in the most ordinary family (Rollins, 2013). In the study, seeing something familiar with which he or she could identify, drawing and talking about it with the researcher served to facilitate the important process of sharing family stories.
other children seemed to be seeking comfort in the familiar through viewing the animals. Contemplating the dogs in the photographs often reminded the children of their own pets or those of family members (e.g. “It reminds me of the dogs I see at home.”). Although in some instances their responses were animated with colorful stories and laughter, the response from the boy far away from home and family revealed homesickness. Hospitalized children of all ages, including adolescents, can experience homesickness. In fact, at a rate of 88%, homesickness may be one of the most predominant types of distress hospitalized
ARTS & HEAlTH 15
children experience (Thurber, Patterson, & Mount, 2007). not all children are homesick for their parents. A child may most miss the family pet. The vintage photographs that included dogs brought these thoughts to the surface. Counter to what some people may think, talking about homesickness is not going to make it worse. one of the coping strategies recom-mended for homesick children is talking to someone about it to promote social support (Thurber, Walton, & The Council on School Health, 2007). Here too, seeing something familiar, drawing and talking about it with the researcher helped a homesick boy start processing his feelings.
Many hospitals have introduced animal-assisted therapy – more commonly known as pet therapy – to pediatric patients, with decreased anxiety a commonly reported outcome (Goddard & Gilmer, 2015). At the risk of overreaching, we ask, could children benefit from having vintage photographs of dogs and other animals in the hospitals as a means of virtual pet therapy or pet therapy by proxy? Anecdotal evidence exists in two cases where photo-graphs of animals have been said to boost the spirits of hospitalized children. In the first case, a children’s hospital created a “Cat Immersion Project,” calling on Facebook fans to post photographs of cats to improve the stay of a homesick teenager with cancer who missed her cat (Jaslow, 2012). In a more recent case, the mother of a friend of a teenaged boy with leukemia asked people to post photos of dogs on Facebook (Putnam, 2015). It was reported that whenever the boy looked at the photos he smiled.
Regarding the theme seeing something cute, three study participants referred to photo-graph #2 Girl with bear cubs as cute (e.g. “I think they’re cute.” “I like the one with the bears because they are cute.”). Research shows that looking at objects deemed “cute” (e.g. puppies, kittens, other baby animals) captures the viewer’s attention (Brosch, Sander, Pourtois, & Scherer, 2008), brings a smile to the viewer’s face (Schleidt, Schiefenhovel, Stanjeck, & Krell, 1980), induces motivation and behavior for approach and caregiving (Glocker, langleben, Ruparel, loughead, Valdez, et al., 2009) and activates the reward system of the brain (Glocker, langleben, Ruparel, loughead, Gur, et al., 2009). A total of five children identified this photo as their favorite, perhaps attracted to this caregiving aspect.
Fully, half of the participants offered finding something funny as the reason for their selec-tion (e.g. “It’s funny. The boys are just having fun. They probably had trouble getting stuff on the dogs.”) The scenes in #1, #2, #4 and #5 all have elements of humor. The children laughed when looking at and discussing the photographs, and many children went on to relate humorous stories of their own. Veatch (2009) describes humor as “affective absurdity” for its ability to change a person’s perception of and emotional response to a situation. There is growing recognition among pediatric health care professionals that humor can be an effec-tive distraction strategy in health care settings (Hart & Rollins, 2011). For example, Berger, Wilson, Potts, and Polivka (2014) conducted a quasi-experimental study with 78 children to determine the effects of distraction through humor on anxiety among children having out-patient surgery. They found that children entering the surgical waiting room environment on Wednesdays when employees were dressed in “wacky” attire had significantly lower anx-iety scores on admission to surgery than children in the control group who came on other days when employees wore routine uniforms and behaved in their usual manner.
About the final theme, liking what they saw, overall, children’s responses to restored vin-tage photographs in a hospital setting were favorable. Even when they did not understand the images, their curiosity was aroused. Their statements and observation confirmed that they enjoyed viewing the photographs and talking about them, thus promoting storytelling,
16 J. RollInS AnD K. E. WAllACE
a form of positive distraction. Having children draw in response to their chosen photo tended to increase their interaction with the images and enrich their verbal responses, a process that lengthened the time period of both passive and active arts engagement.
Some of the findings from the analysis of gender, age and nature of disease were inter-esting, but with the small sample size and uneven gender distribution, nothing conclusive can be said. of interest, regarding gender and choice of photograph, findings showed that more boys than girls chose the photo #1 Dogs and children, which featured boys, and more girls than boys chose #2 Girl with bears, which featured a girl. one might guess that children were identifying with their gender. It is difficult to say anything significant about age, again due to the small sample size and age distribution, other than that the 12- to 14-year-olds selections were more distributed. Regarding nature of disease, we had wondered if nature of disease (life threatening vs. non-life threatening) might be a factor in the selection of photo, for instance, active vs. passive scenes. However, children with life threatening diseases were represented in all photo choices but one, #4 Goose pulling carriage. From this small snapshot, it may seem as if having a life threatening disease is unrelated to photo choice, but again, the small sample size and lack of the use of more robust methods render this finding simply a matter of interest to be explored at another time.
The viewing/interviewing/drawing process
The study methods comprised a creative therapeutic intervention that enhanced commu-nication and provided a safe environment for some children to explore their feelings with a caring adult. open-ended questioning brought children more deeply into observing and thinking about the photographs – taking the images in – than would likely have occurred by merely pointing out photographs and asking yes and no questions. For instance, following children’s responses to “What do you think is going on?” with “What do you see that makes you say that?” or “What makes you think that?” were helpful and allowed children to support or revise their answers based on their closer observations of the work.
Engaging in art making allowed the children to make decisions in an environment where their choices are often few and not always honored. Having this opportunity gave children a much-needed sense of control over something in their lives. It allowed them to be the active ones, in a place where they are often only the recipients of the actions of others. For some children, the experience provided an opportunity to share thoughts and feelings. For all of the children, it fostered a normal and familiar experience; engaging in expressive activities such art and play is the essential work of childhood.
Children in hospitals benefit from social interaction in attempting to cope with hospital and illness stressors (Rollins, 2009a). Some children in this study participated in lengthy social interaction with the researchers during interview. Children seemed to enjoy providing their opinions, drawing and interacting with the researchers and others who were present. They were able to engage in storytelling.
As a therapeutic intervention, The Vintage Photograph Project offered a cost-effective experience that children found enjoyable, interesting and even educational. limited supplies were needed for the interviewing/drawing activity – vintage photographs, paper and art supplies. Art supplies are typically readily available in pediatric settings. Properly prepared artists, child life specialist, nurses or others with knowledge and skills in the psychosocial care of children in hospitals can facilitate the intervention.
ARTS & HEAlTH 17
Although the intervention could be facilitated in a group setting, the intimacy of the one-on-one interaction provided an opportunity for the child and facilitator to learn more about each other, the basis for the connected relationships very sick children tell us they need (Rollins, 2009b). The culmination of the project with an exhibition with other children’s work let children know that they were part of a larger community.
Limitations
There are major limitations to this study. Although appropriate for a qualitative study, the sample size was small, made smaller when accounting for differences in children’s ages, with each age group in fact a unique population. Also, with more girls than boys, there was unbalanced gender representation. Additional ethnic diversity and diagnostic characteristics might have resulted in a different range of photo choices. Presenting two versions of the same photograph – one in black and white and one sepia-toned – would have been a more effective way to obtain children’s preferences on this factor, which would have ruled out the possible influence of subject matter. Further, to determine whether vintage photographs can serve as positive distractors for children in hospitals requires a comparison of hospitalized children’s perceptions of vintage photographs with those of non-hospitalized children, and comparisons of perceptions with a range of other types of artwork, activities that were well beyond the scope of The Vintage Photograph Project.
Conclusions
Restored vintage photographs are of interest to hospitalized children and should be con-sidered when preference studies are conducted regarding potential for positive distraction in hospitals serving children. The images were able to capture the attention of children, an essential characteristic for any type of positive distractor.
The pairing of art taking (passive engagement in art) and art making (active engagement in art) was effective. The study protocol not only enriched interview findings but also pro-vided an enjoyable experience for children and the researchers to share. Future research is needed to explore the effectiveness of The Vintage Photograph Project intervention in help-ing children cope with the stressors of hospitalization and illness.
Disclosure statement
no potential conflict of interest was reported by the authors.
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