Abstract
From 2021 to 2023, the Pima County Health Department earmarked 1% of its pandemic relief funding to support a partnership with the Arts Foundation for Tucson and Southern Arizona for a social art initiative in five communities disproportionately impacted by COVID-19. Community participants worked with artists to represent their experiences during the pandemic and their hopes for the future. The resulting art installations were unveiled at county-wide art and wellness events. As part of program improvement, an informal pilot evaluation was conducted and participant self-assessments showed high satisfaction, increased confidence in health care access, and appreciation for the impact of public art on social cohesion and belonging. Lessons learned from working in low-trust communities include the importance of removing barriers to participation, recruiting locally, and anticipating critics. The allocation of dedicated funding through a percent-for-social-art approach should be considered an emerging best practice for public health departments to improve health, support social cohesion, and build trust after a sustained traumatic event.
Keywords
The COVID-19 pandemic exacerbated socioeconomic and health disparities among historically and contemporarily excluded U.S. communities. These disparities, combined with the rise of misinformation during the pandemic that undermined the credibility of science-based messaging, weakened trust between public health institutions and the communities they serve. Restoring trust in public health institutions and bolstering social cohesion remain key challenges in the post-pandemic era (Hall et al., 2023; Klein & Hostetter, 2023).
A growing body of research recognizes the positive impact of civic engagement and art-based initiatives on health and social cohesion, especially after sustained traumatic events (Baumann et al., 2021; Dubowitz et al., 2020; Jewett et al., 2021). “Bridging the gap” between public health and art (Galea, 2021) has been shown to improve mental and physical health outcomes (Karkou et al., 2022), build trust around sensitive health topics (Sonke et al., 2021), and mitigate the health impacts of structural social vulnerability by increasing “confidence and self-determination” (Gordon-Nesbitt & Howarth, 2020).
Social art is a collaborative process in which professionals, such as artists and social workers, collaborate with nonprofessionals to co-create art products that produce meaningful social change (Shefi et al., 2022). This research brief presents an informal pilot evaluation of SaludArte, a social art initiative co-created by the Pima County Health Department (PCHD), the Arts Foundation for Tucson and Southern Arizona (Arts Foundation), and five Pima County supervisory districts. Pima County shares the longest contiguous border with Mexico of any county in the United States (Garcia, 2023) and has a diverse population that includes transitory, seasonal residents and Indigenous and Latine/a/o populations (Pima County, 2025). Pima County has a relatively high social vulnerability score of 0.88 as measured by the Centers for Disease Control and Prevention (CDC) Social Vulnerability Index, a standard metric that aggregates factors such as access to health care services, health insurance coverage, and transportation to assess a community’s susceptibility to emergencies (Federal Emergency Management Agency, 2018). From 2021 to 2023, SaludArte sought to advance health equity, improve health literacy, and build confidence in public health and COVID-19 vaccines through a community-led process to represent the pandemic experience of under-served communities through temporary art installations.
Method
The development and implementation of this social art initiative were crucial components of the methodology, as they were designed around a human-centered approach to gathering community input to co-create an initiative driven by the needs of the communities being served. As one component of the larger community project described in Ackerman et al. (2025), SaludArte underwent an informal evaluation for program improvement and did not require Institutional Review Board (IRB) approvals.
Program Development and Implementation
To identify the communities of focus, PCHD gathered longitudinal COVID-19 data on the social determinants of health and social vulnerability. With qualitative input from the Supervisory District Offices, these data were further refined to select one or two zip codes in each of the five districts that were disproportionately affected by COVID-19 and had low access to resources and health interventions. Fifteen community participants for each district were recruited at local events and community centers. These participants served on district committees that would select the artists and guide the social art process. At the same time, a call to artists with a demonstrable connection to these communities was issued.
Participants attended four meetings from January to August 2023 to: (1) learn about the role and value of civic engagement in the public art process, (2) select an artist to represent their pandemic experiences, (3) share their experiences and hopes for the future, and (4) offer feedback on artist proposals. The objectives for these meetings are listed in Table 1.
Community Meeting Objectives
At the first community participant meeting, each district committee selected three finalists from the body of artist applicants. At the second meeting, the top three artists presented their practice, intention, and understanding of the project. Community members voted to select the winning artist to represent their stories and aspirations.
The third meeting allowed participants to share their pandemic experiences and their hopes for the future of their community through human-centered design activities (Table 2) that captured qualitative and quantitative input such as timelines, narratives, audiovisual memories, and geographic maps showing the location of actual and desired resources and services. The artists then incorporated these experiences into their artwork. At the fourth and final meeting, artists presented their vision of the artwork and gathered feedback from the participants before moving into production.
Human-Centered Design Activities and Application of Data Outputs
The project culminated with a community-led art and wellness celebration in each district. Community participants curated the event objectives and activities. In addition to performances by local artists such as musicians and dance groups, the celebrations offered community and health resources such as COVID-19 vaccines and tests, screenings for sexually transmitted infections, general health screenings, and employment and housing resources. Community members in attendance could also participate in raffle drawings for health-related prizes, gift cards, art classes, and tickets to local performance art events.
Evaluation
Evaluation activities for SaludArte began in Spring 2023. The measures used for this study were collaboratively developed by the evaluation team in consultation with the Arts Foundation and PCHD to ensure they reflected the goals and needs of all partners. While some survey items were adapted from existing validated tools measuring health literacy and community engagement, the majority were tailored to the specific cultural and contextual aspects of the SaludArte program. As such, the evaluation strategy maximized data collection during the celebrations, using surveys to measure program impact, health literacy levels, and overall satisfaction data of the celebrations and community artworks.
Recruitment
SaludArte celebration attendees received a bingo-like resource card to confirm they visited all the resource stations at the events. The last station was staffed by the evaluation team, who invited participants to complete a voluntary, online Qualtrics survey on a tablet or by scanning a QR code. The participant had the choice of English or Spanish and could complete the survey in writing or orally, with a team member to read the questions and input their responses. Participants who completed the survey were given a ticket for a raffle at the end of each event.
Thirty-six closed- and open-ended questions provided quantitative and qualitative insight on participant demographics, understanding and appreciation of art installations, and awareness of health resources. The survey included a five-item scale on community resources (e.g., How aware were you of the following community resources: low-cost health care, vaccination, water bill assistance, home repair assistance), a 14-item dichotomous scale on accessibility services (e.g., Did you benefit from any of the following accessibility services at this event?), and 4 questions on social and social justice issues with an emphasis on health equity. Participants were asked specific questions about the art and artist, which included scales to assess their understanding and appreciation of the art and whether the art captured and represented the attendee’s lived experiences around COVID-19. This approach allowed participants to express their sentiment about the art, revealing meaningful connections and experiences.
For community meetings, the team employed a survey with the same demographic questions asked of SaludArte participants and four questions on satisfaction with the community meetings. In addition to the survey, the team conducted a secondary analysis of the community meeting notes and brainstorming activities that examined themes of health literacy, vaccine access, and the community impact of the COVID-19 pandemic.
Results
A total of 43 community meeting members completed the evaluation survey. The demographics of the community meeting members consisted primarily (67%) of female-identifying individuals (n = 29), with 46.5% identifying as Latine (n = 20) and 46.5% identifying as White (n = 20). A total of 92 participants of the SaludArte events completed the evaluation survey. The demographics of the SaludArte participants consisted primarily of 63% female-identifying individuals (n = 58), with 43.5% identifying as Latine (n = 40) and 41.3% identifying as White (n = 38), 7.6% identifying as Indigenous/Native American (n = 7), 6.5% identifying as Black/African American, and 1% identifying as Asian/Pacific Islander.
Preliminary self-assessments from community meetings and Celebrate SaludArte events found high participant satisfaction, increased health care confidence, and appreciation for being “included and heard.” The community meetings revealed themes of community resilience, personal struggles, government responses, loss and grief, values, hope for the future, and unmet local needs (Table 3). These themes reflected the diverse experiences and perspectives across districts, emphasizing the collective resilience of communities, the impact of personal struggles, reflections on governance and systems, the pervasive sense of loss, and hope for positive change in the future.
Exemplary SaludArte Participant Responses
Survey results also revealed that the SaludArte activities increased participants’ confidence in accessing health resources, awareness of health literacy and health equity issues, and likelihood of participation in COVID-19 mitigation practices. One participant wrote, “This is the first time I felt part of the community; I felt worth something.” The celebrations also received positive feedback. Eighty-nine percent of surveyed attendees felt highly satisfied or very satisfied, and 74% felt highly represented by the artwork. Both verbal and written comments from celebration attendees requested additional opportunities like SaludArte: “We need more events like this one. A lot of people need help.”
Discussion
Sustained traumatic events in underserved communities can exacerbate mistrust of government agencies and other large external organizations. The social art process helped rebuild trust in public health and promote health-seeking behaviors. We offer the following lessons to local public health practitioners who share these goals.
Identify Structural and Material Barriers to Participation
The social art and community-design process should include accommodations to remove structural barriers to participation and level power distribution between large organizations and the community participants invited into the process. Programmatic practices should center the leadership of community members to design their experience throughout the project. For example, the community participants in Ajo, the most rural district in the SaludArte program, reviewed and declined all initial artist applications as having insufficient ties to their community, based on the published criteria of “Community Connection” within the Call to Artists. In response, the Arts Foundation re-opened the call to artists and held artist application workshops in Ajo to help aspiring local artists develop competitive applications. The result was an overwhelming application cohort from the Ajo area. The Ajo district committee unanimously selected the most qualified finalist, who not only exceeded all criteria but who, as an artist from Ajo, better understood and could represent their shared experience.
Incorporate Evaluation Into Every Stage of Program Design
The social art process presents unique challenges to existing impact assessment methodologies. Garnham and Campbell (2016) call for “a degree of creativity [. . .] both in terms of what we demand from arts-based interventions and from our research and evaluation of them.” In the case of SaludArte, failure to incorporate the evaluation team into early strategic planning and program design limited our ability to capture a baseline by which to measure later findings. Practitioners may consider co-creating the evaluation plan, measures, data collection points, and evaluation analysis with collaborating community partners to ensure a community-based participatory approach.
Anticipate Critics
In the current political climate, funding for social art may receive significant scrutiny. In Pima County, a December 2020 resolution by the Board of Supervisors that declared racism a public health crisis and advocated practices to promote health equity provided political support for the allocation of funds toward social art (Pima County Board of Supervisors, 2020).
Hire Locally
The success of our community recruitment efforts was largely due to the decision by the Arts Foundation to hire a Community Design Manager who led the outreach and recruitment efforts for community participants and artists. With her local community ties and status as a trusted messenger, she could leverage her existing community connections to bolster the work at inflection points throughout the project.
Retain Adequate Support Staff Throughout the Project Duration
Staff shortages within the PCHD team emerged as a notable limitation. The success of any meaningful community engagement program relies on consistent staffing. Likewise, evaluation relies on a dedicated and adequately resourced program team to streamline data collection. The lack of sufficient program personnel may have impeded the depth and quality of evaluation efforts.
Maintain Consistent Funding for Social Art
During the COVID-19 pandemic, the PCHD received four COVID-19 grant awards from the Department of Health and Human Services’ (HHS) Office of Minority Health (OMH), the CDC, and the Arizona Department of Health Services (Ackerman et al., 2025). Approximately 1% of each award was reserved for SaludArte. To ensure the program remained in funding compliance, SaludArte crosswalked program activities with each grant’s guidelines, objectives, and spending policies to form three braided but discrete work streams: administration, artist payment, and community meetings/celebrations. Departments seeking to establish a percent-for-arts and/or social art programming should build in ample time to navigate similar administrative hurdles before programmatic work begins.
Coordinate Funding With Stakeholders
The braided funding mechanism required approval from, and coordination with, grantors as well as county leadership and entities responsible for compliance and grant activities. However, participatory processes yielded unforeseen costs, such as a request by participants for performance artists at the community celebrations. When possible, the grants were amended to cover these emergent costs. When costs were prohibited by federal funding guidelines, the community partner assumed the expense. To avoid the latter outcome, program architects should (1) acknowledge in the application for funding that costs and activities will be emergent and responsive to community needs and (2) work with funding officers and coordinating departments such as procurement, finance, or grants management to establish efficient protocols for approvals of emergent costs.
Implications for Practice
The outbreak of the COVID-19 pandemic deepened social and political rifts to the point that public health workers were receiving death threats. In this environment, assembling community members to discuss the pandemic was fraught with risk. The social art process provided an entry point to a justifiably hesitant community. The activities were crafted to solicit community expertise in a nonthreatening way that allowed participants to choose their level of engagement. Even those participants who initially rejected science-based messaging nevertheless engaged with the activities, took value from the program, and sometimes came to embrace public health messaging. In a time of ongoing division and social inequity, wherein public health issues such as gun control, maternal health care, and the opioid epidemic are increasingly politicized, social art bridges gaps between health departments and the communities they serve, building greater trust and improved health outcomes in meaningful ways that this disharmonious moment demands.
Pima County, with support from opioid settlement funding from the HHS and the CDC, remains committed to funding social art through its 2025 SaludArte 2.0 program, which seeks to reflect the experiences of people impacted by the opioid epidemic and increase their trust in the institutions that serve them. As public health faces a leaner and more uncertain funding environment, we consider the allocation of a set percentage of grant funding awards for social art initiatives – a percent-for-social-arts practice – an emerging best practice for public health.
Footnotes
Authors’ Note:
We would further like to thank scientific editor Matthew Jager; Natalia Molina, creator of the name “SaludArte” and former Program Coordinator; and Partners in Health for assistance in incentivizing community member participation. The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Ada M. Wilkinson-Lee and Imelda G. Cortez provided evaluation for two programs that funded SaludArte. The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by grant funding from the Office of Minority Health, CDC, and ADHS. None of the aforementioned had input into the development or content of these materials.
