Fostering collective impact in arts-based interventions and cultural programmes for creative well-being of older adults

Despite growing interest in research into how the arts impact older adults’ health and well-being, there are many related complexities that are yet to be fully understood. This is partly due to the fact that documentation and analysis of arts-based interventions and cultural programmes for older adults in the public service domain are relatively new and uncommon. Furthermore, the effective implementation and the delivery of such interventions to ageing people generally involve many stakeholders, often with divergent interests and priorities. This article presents an interview-based study that explores the diverse experiences of professionals from different sectors who have been involved in delivery of arts-based interventions and cultural programmes for older adults in South Korea and Finland. The study maps out similarities and differences in the approaches taken and the challenges faced in such interventions, using the five themes of the narrative interviews that have been conducted. The study findings highlight the need for supporting collective efforts among the diverse stakeholders to provide effective arts-based interventions and cultural programmes for ageing people. We argue that such efforts will ultimately


Introduction
There has been a growing interest in recent years in seeking better provision of services and support mechanisms for older adults in many rapidly ageing societies around the world (Lee et al. 2023;WHO 2015).Similarly, following a significant increase in research into the impact of the arts on health and well-being, both the arts and health sectors have become more interested in the benefits of different arts-based interventions and cultural programmes for older adults (e.g.Cox et al. 2010;Noice et al. 2014).
Despite these developments, the documentation and analysis of artsbased interventions and cultural programmes for older adults in the public service domain are however, relatively new and generally uncommon.Yet, it is also more increasingly acknowledged that such interventions and programmes involve many complexities that need to be better understood, if the aim of the public sector to improve their efficacy and sustainability is to succeed.This is due to the fact that currently it is not clearly known what factors contribute to making arts-based initiatives more effective, or how such initiatives can be sustained long-term in different communities and across cultures.
To address this knowledge gap, we have conducted an empirical study of arts-based interventions and cultural programmes for ageing people.This cross-cultural interview-based study presented here investigates diverse personal experiences of professionals from different sectors who have been involved as stakeholders in arts-based interventions and cultural programmes for older adults in South Korea and Finland.The study examined these two countries because, despite their cultural differences, their rapidly ageing populations pose similar challenges to their policy-makers and fiscal institutions, because of increasing economic constraints placed on their decreasing workforce (Finnish Institute for Health and Welfare 2023; OECD 2018).By choosing two countries with similar levels of industrialisation, and presumably different cultures -European and Asian -and approaches to ageing, we aimed to not only focus on the similarities between them in the ways they target their ageing populations using arts-based interventions and cultural programmes, but also to identify any significant differences they may have on account of their distinct cultural characteristics.Therefore, the goal of this study was to provide a shared understanding of the necessary organisational skills and capacities needed for maintaining effective arts-based interventions and cultural programmes, and to allow making comparisons across the cultural contexts of the two selected countries in their approaches to resolving existing challenges in providing these public services to older adults.
Arts, Health, and Well-Being of Ageing People Ageism, or discrimination based on age, against older adults is sadly so widespread in our modern world that it affects many different aspects of the lives of ageing people (Comincioli et al. 2022), including the provisions for their healthcare and general well-being.One of the ways of combatting ageism is to consider the impact of creativity as an effective life-long human ability, rather than always focussing only on physical or mental capacity that naturally decreases with ageing.Targeting late-life creativity through arts-based interventions and cultural programmes is indeed a viable and effective means of improving the health and well-being of ageing people (Archibald & Kitson 2020).
The effective implementation and delivery of arts-based interventions and cultural programmes to ageing people are, however, complex processes involving many stakeholders from different sectors -often with divergent interests and priorities.In this article, we briefly review some of the relevant concepts that need to be understood and addressed when bringing together different stakeholders, with their conflicting interests and concerns, in these types of interventions and programmes for older adults.

Client Orientation
Older adults have been increasingly involved in the field of ageing studies as users and co-researchers, by engaging in planning their own healthcare and other related services (Lee & Masoodian 2023).Bindels et al. (2014) stress that "aging research finds itself in a new situation, with a top-down trend towards consumerism, increased user involvement required by funding agencies and a bottom-up surge of social movements comprised of older people who desire increased control over the decisions which affect their lives" (p.2).This has given rise to a client-oriented approach, which is not only becoming one of the core features of the modern healthcare and social services for ageing people, but also an essential part of older adults' social and cultural rights (Kallio et al. 2022).
In Finland, the national AILI Network1 for arts-based care for older people has recently developed a system called "Creativity, Art and Cultural Profiling" (Siponkoski 2021), following the client-oriented approach to offering better services by integrating the documentation and assessment of arts-based work with older adult clients.This approach promotes the incorporation of creativity, cultural activities, and arts-based care through a more comprehensive involvement of all the stakeholders concerned, including the older adults and the arts and care professionals (Siponkoski 2021).In addition, the approach aims to create systematic support to better enable older adults to benefit from their cultural rights in their everyday lives by facilitating and standardising information exchange within arts, culture, healthcare, and social welfare sectors (Siponkoski 2021).
The client-oriented approach has also been investigated through several qualitative research conducted with the Finnish health and social care services.As a result of these studies Kallio et al. (2022) have, for instance, identified "a human approach," "the client's rights," and "the perceptions of the client as a responsible party" as the key features of the client-oriented care and services for older adults.According to them, these features enable achieving equality between older adult clients and professionals, while pursuing the clients' best interests, and supporting them in responsible decision-making and service engagement (Kallio et al. 2022).
In comparison, the demand for client-oriented care -also called person-centred care -is increasing in South Korea, due to many older adults these days living in residential care facilities (Chin & Lee 2023).
The main concern, however, is that existing methods and tools of implementing person-centred care used in South Korea are only direct translations of methods and tools used elsewhere, and as such new methods and tools are needed to be developed that more accurately reflect the reality of care facilities provided in South Korea (Chin & Lee 2023).Despite this, there have been numerous evidence-based investigations that examine the effectiveness of client-oriented approaches in different care sectors for older adults in South Korea, including occupational therapy, daycare services, care for people with mild cognitive impairment or dementia, and the like (e.g.Baek & Jung 2016;Chin et al. 2021;Park & Kwon 2019).
The client-oriented approach together with "person-centred planning" -which is rooted in the philosophy of partnership and equality -can ultimately provide an important starting point for building a co-productive relationship by empowering hitherto excluded people (Coulson 2007).Therefore, when developing arts-based interventions and cultural programmes for older adults' that target their creative well-being, the approaches taken should be applied -from planning to evaluationin a holistic way by integrating the collective efforts of the professionals involved from different sectors and the clients themselves -that is, older adults -on the basis of a constructive and substantial partnership.

Collective Effort Towards Collective Impact
Collaborative practice and teamwork are key competencies for working effectively in an interprofessional setting (Suter et al. 2009).In the fields of the arts and health in particular, interdisciplinary work can, however, be rather challenging due to a wide range of disciplines and agencies being involved (Jensen 2019).For this reason, interest in finding new methods for developing and translating related research knowledge into practice has increased in recent years, with the aim of supporting a wide range of stakeholders -including decision-makers, practitioners, and healthcare clients -in learning and altering their attitudes and behaviours (Boydell et al. 2016).
In this regard, effective coordination is clearly an important element of successful collaboration involving stakeholders from different sectors.Fortier and Coulter (2021) highlight that a multifaceted approach to public health services requires understanding the dynamics of cross-sectoral collaboration, with the capacity to design and coordinate services between the arts, health, social care, and community organisations.Such mutual understanding leads to successful collaboration and relationships while negotiating different mindsets, institutional goals, capacities, and resources (Fortier & Coulter 2021).Banks et al. (2017) point out that the idea of "co-production" or "co-creation" emerges when many different contributors work together in a coordinated process, and the resulting impact emerges as a "collective impact" or "co-impact."According to Banks et al. (2017), the concept of collective impact is used in relation to "the context of multiple organizations working together strategically to achieve social change, where interventions are co-designed to tackle 'wicked' (intractable) issues" (p.543).As such, co-impact is "an umbrella term referring to the generation of change as a result of individuals, groups, organizations working together" (Banks et al. 2017, p. 542).
Based on the aforementioned, we would argue that understanding the dynamics of collective efforts and impact could be the key to addressing global collective challenges, such as those relating to ageing populations.Indeed, various communities and organisations are already adopting a different mindset to bring about large-scale systemic change through collective impact (Turner et al. 2012).Therefore, collective impact would seem like a useful concept to adopt for developing a coordinated approach for effective arts-based interventions and cultural programmes targeting the health and well-being of older adults.

Empirical Study
To investigate the diverse perspectives and experiences of different cross-sector professionals involved in arts-based interventions and cultural programmes for older adults, we have conducted an empirical study in Finland and South Korea between 2019 and 2022.The objective of this comparative study has been to better understand how the notion of client-oriented approach and collective effort is implemented in these types of interventions and programmes in two different cultural settings, as well as other factors that affect the coordination of such interventions.

Method of Study
In this study, we used a form of open interview method which seeks to ascertain personal narratives of the interviewees' experiences (Lee et al. 2023).As narratives are always part of the existing social, cultural, and political settings, in the analysis of this type of interviews it is crucial to consider the context of the "narrative constitution of selves, identities, and social realities" (Hyvärinen 2008, p. 447).Therefore, the use of narratives in this study has focussed on their function as a means of sharing and disseminating narrative knowledge in the form of stories and direct accounts of personal experiences (Gabriel 2015).Sharing narratives and experiences about mundane everyday problems or greater global challenges through stories can in fact become a basis for communities of practice (Gabriel 2015) and provide diverse complementary perspectives for resolving common concerns.While the concept of narrative knowledge has emerged from organisational studies, it should not be restricted to "folk wisdom" and mitigated as a "surrogate for scientific knowledge," but rather, it should be considered as an important form of tacit knowledge shared among professionals and managers as well, including those working in scientific fields (Gabriel 2015, p. 287;Jetoo et al. 2023).In addition, our study has also relied on the retrospective dimension (Freeman 2015) as a valuable feature of narrative interviews, since it allows seeing past events as "episodes that are part of some larger whole" (Freeman 2015, p. 27).

Interviews of Practitioners and Professionals
In this study, seven art practitioners and seven professional staff members from several institutions, cultural foundations, and non-profit organisations were interviewed in Finland and in South Korea.The participants had experience of working on arts-based interventions and cultural programmes with older adults in different settings.Table 1 provides a summary of the study participants' backgrounds and experiences.Due to the coronavirus disease 2019 (COVID-19) pandemic restrictions in place during 2020-21, most of the interviews were conducted online using video conferencing tools, with a few of them taking place face-to-face or through email.All the interviews were conducted individually and took 60-90 minutes each.

KP4
A team leader Institutional official Works in a provincial art and cultural foundation based in the northeast of South Korea.These public foundations in each province provide various cultural and artistic events for the residents.This foundation promotes enjoying art on a daily basis and aims to provide residents with a full sense of cultural experience.

KP5
Project manager Institutional official Same as above for KP4.

FP2
Art instructor, artist Practitioner Makes and uses art as a means to meet new people and improve self-identity.Guides a group of people to make art together at a local community centre, shares knowledge and philosophy of art with them, and encourages their art-making process through peer support. (Continued)

FP5
Director Practitioner and institutional official Works for a non-profit organisation located in the western part of Finland, aiming to increase the societal value of cultural experiences, and emphasising arts, culture, and creativity as an essential part of human rights, and the importance of cultural services for well-being.

FP6
Project coordinator Institutional official Works for a community cooperative in an eastern district of Helsinki.They aim to maintain old neighbourhoods and support local people in the region.They offer a place for organising cultural events, and different courses to help all the residents to mingle together and network.

Cultural instructor
Institutional official Works for a city-based residence for older adults in Helsinki, aiming to support self-sufficiency and active life in old age.
Working closely with a community care facility next door to the residence, they offer comprehensive services by collaborating with nursing staff, physiotherapists, occupational health therapists, and cultural instructors.
An information sheet explaining the purpose of the study was sent to the participants prior to the interviews.Participation in the interview was completely voluntary and based on informed consent.The study was reviewed by the research ethics committee of Aalto University.The first author conducted the interviews either in English or Korean, depending on whether the interviewees were in Finland or South Korea.All the interviews were audio-recorded and transcribed by the first author.Transcripts were pseudonymised to protect the participants' identities and any confidential information shared during the interviews.
Table 2 provides a summary of the five thematic categories of interview questions, focussing on: 1) motivation and planning, 2) methods and strategies, 3) value for older adults, 4) evaluation and reflection, and 5) sustainability and networking.When necessary, the interviewer used examples to prompt the interviewees to elaborate on their experiences by focussing on the retrospective dimension.Most of the conversations in the interviews centred on personal experience from organising or facilitating arts-based interventions or cultural programmes for older adults.As discussed earlier, the use of a narrative inquiry method in this study was based on the function of narratives as a means of sharing knowledge and Table 2. Different categories of questions used in the interviews, together with example prompts

Theme categories
Example keyword prompts

1: Motivation and planning
Goal; aim; mission; planning process; promoting programmes; funding resources

2: Methods and strategies
Working strategies; role of practitioners and institutional officials

3: Value for older adults
Value and importance; health benefit (mental and physical); late-life creativity; social impact

4: Evaluation and reflection
Evaluation methods; assessment; measurement; feedback; monitoring and consulting; opportunities and key success factors; challenges and complications

5: Sustainability and networking
Sustainability of programmes; employment; training and seminars; workshops; core elements for collaborative relationships and partnership; ways of communication personal experiences.Therefore, the objective of the interviews was broader than just hearing about their personal experiences, but rather, the aim was to also find out about their working strategies in a comparative and cross-cultural context.

Data Analysis
The purpose of our interviews was to allow the interviewees to narrate their everyday lives, in their relative entirety, or some interesting parts of them (Nohl 2010).This approach is often used as an analytical framework for understanding a wide spectrum of human activities (DeVereaux & Griffin 2016).Keeping this potential in mind, the first author analysed the transcribed data and notes from the interviews using a content analysis method and iterative thematic analysis process.
Content analysis is a widely used method for making replicable and valid inferences from data to their context, which can provide knowledge, new insights, representation of facts, and practical guide to action (Elo & Kyngäs 2008; see also Krippendorff 1980).Content analysis of verbal communication, therefore, produces a broad, but condensed, description of the phenomenon being investigated, and leads to identifying a set of concepts or categories that describe such a phenomenon (Elo & Kyngäs 2008).In this study, the content analysis was carried out inductively by comparing and overlapping the transcripts across all the interviewees' statements under the five theme categories of the interview questions (see Table 2).This allowed generalising the results based on specific instances observed in the study data, and combining them to create general statements (Elo & Kyngäs 2008, see also Chinn & Kramer 1999).The commonly emerging keywords were categorised under the five primary themes of the interview questions without considering the cultural or societal context of the specific country -Finland or South Korea -to allow mapping out similarities across all interview data.After this coding, unique cultural differences between the two countries resulting from their different political and social welfare systems, national characteristics, administrative operations, and so on were identified.

Study Findings
Figure 1 provides an overview summary of the main thematic categories, generic categories, and sub-categories resulting from the content analysis process described above.Here we present the main findings of our study using the five main thematic categories of our interview questions and data analysis.The study provides many valuable insights into how artsbased interventions and cultural programmes are designed, managed, and evaluated in the two countries investigated.

Theme 1: Motivation and Planning
The interviewees shared various different motivations and reasons for initiating arts-based interventions and cultural programmes for older adults.In both countries, the main motivation behind most of these programmes was derived mainly from perpetual societal concerns about the loss -or at least disruption -of community values and older adults' decreasing social engagement.Individual art practitioners and professional staff in organisations considered a range of social issues as threats to better community development.Issues such as the economic and cultural marginalisation of ageing people, and the lack of community cohesion and supportive environments for older people throughout their life-course were perceived as leading to alienation and isolation, particularly in the case of long-term residents of local communities.Therefore, arts-based interventions and cultural programmes were organised to provide equal access to opportunities and build mutual respect between all community residents -both long-term locals and new migrants -and to increase their social engagement within the artistic environment.These interventions and programmes focussed primarily on positive perspectives of artistic engagements, such as having fun time together, or providing occasions for healing while playing for instance with colours and materials.Overall, community integration was one of the primary motivations in both countries for arts-based interventions and cultural programmes.
In one example from Finland, the reason given for offering a community space and organising social and arts events for the local long-term residents was to help everyone mingle and build social networks together as a way of supporting them during a regional development process, in which social infrastructures such as libraries and community care facilities were relocated to a newly developed area, away from their old neighbourhood, thus leaving the local long-term residents with a weakened sense of belonging and a feeling that they were alienated and isolated.Talking about this issue, FP6 said:2 "Most of the community facilities (e.g.library, youth center, etc.) are moved to the newly developing area, so some of the long-term residents came up with the idea of creating a common place to support old neighbors' social activities.We promoted different events together; for example, distributing program posters around the neighborhood when people take a walk with their dog.Our collective efforts enabled us to continue with our social engagement and make our community active together." In comparison, in South Korea the arts-based cultural programmesespecially community-based ones -were needed for immigrants or people who had newly moved to a region due to family reasons or new jobs.In these cases, new people were struggling with integrating into local networks, while the local residents who were born and raised in the region had already established strong relationships amongst themselves.Therefore, arts-based cultural programmes were organised to support community integration in fun and creative ways.In reference to this issue, KP2 explained what this entails in practice when considering a particular locality: "As this area is a military border zone, most of the residents are made up of the military personnel and their families, foreign immigrants, older people over the age of 60, and housewives.Therefore, the program was planned considering the unique characteristics of the region, and it aimed to create a new community where the dominate natives and marginalized groups of people who are from the outside of the village would actively interact.Our program provided a new opportunity for people to get to know each other and develop community spirit in this area by sharing their concerns and loneliness through artistic ways -a combination of storytelling and drama activities." In terms of planning and launching new arts-based interventions and cultural programmes, the two approaches commonly taken are: 1) topdown or 2) bottom-up.The top-down approach is normally taken when the programmes are funded and developed by, for instance, institutions, municipalities, or foundations.In such cases, at the beginning of the year the major funding agencies announce the annual missions or goals of their programmes, which often stem from emerging social issues.The sub-organisations then either call for artists or art practitioners to apply, or use existing databases to look for local art practitioners who are capable of developing suitable programmes towards their organisational missions.Once the planning phase is completed, in some cases a trial session is carried out with a small group of local older adults.The programmes then gradually expand into larger groups or geographical areas.In some cases, however, the programmes only target a specific community.
A representative example of the top-down approach in South Korea is described by KP7: "As an art and cultural foundation under a local autonomous entity, we don't call practitioners through an official business announcement but design and plan programs on our own, figuring out needs of the residents or following social agendas.Therefore, we initially sketch a program format (e.g.topic, number of participants, location, class content, frequency, etc.) internally, and then recruit practitioners fitting the purpose.We ask the chosen practitioners for detailed content based on our initial working framework and finalize together, through several rounds of feedback, and including some external consultants."As this example shows, even in cases of top-down approach, local needs are often identified first.
The bottom-up approach, on the other hand, is usually based on a grassroot initiative, when a programme is started by a civil association or a non-profit organisation.In such cases, a coordinator may gather initial ideas from a community group or the local residents and assist them with the development of the needed programme.Alternatively, a host or an art practitioner may work with a group of participants and collectively plan the programme, taking into account issues such as the participation fee, scheduling, among others.Yet in other cases, individual practitioners or organisations who have already had a long-term relationship with a broad group of partners and networks, may approach funding agencies and pitch their ideas to gain funding and start their own programmes.
One practitioner in Finland, FP3, illustrated a typical way of planning programmes in the Finnish context based on a bottom-up approach: "As we are funded by a governmental agency, we have a basic protocol and follow certain steps to meet their operational requirements.However, as we mainly pursue a 'bottom-up' approach, we try to identify the wishes of our group of participants thoroughly and design the practices on the basis of communal agreement.This way of planning helps us to sustain our practices in the immediate future, especially when funding ends.Because it's flexible and adaptable to motivate internal and external partners (e.g.community college, volunteers, and municipality) to support the program for a longer term."This example shows the importance of community-based bottom-up approach for sustaining the achievements of short-term projects over longer terms.

Theme 2: Methods and Strategies
Based on our study participants' experiences and learnings, we identified three key methodological approaches or strategies in working for, or with, older adults: 1) client-oriented approach, 2) artistic creation focussed on fun and play, and 3) openness and flexibility.These approaches are also related to the roles of art practitioners in terms of their competencies.

Client-Oriented Approach
In a client-oriented approach, the quality of provided services is improved by involving the older adults as active co-producers of those services, rather than merely their customers.Our study participants described how this approach is taken in practice and how it leads to better results in their experience.
One successful client-oriented approach mentioned was through the so-called cultural profiling.This concept, which has been used by the aforementioned AILI Network in Finland, refers to an in-depth profiling process that leads to intimate interactions between the practitioners and their older adult participants.The underlying idea is that the art practitioners and institutional officials should identify the regional context in which their target group of older adults is located, and the type of art-based interventions they would need in their specific socio-cultural situation.According to our study participants, following this process has led to the success of the interventions and programmes they have offered, and has affected not only how well the practitioners interact with the older adults to moderate appropriate topics and materials that better reflect their interests, but has also helped the older adults to identify their changing values and goals as they age.
One practitioner in South Korea, KP1, gave a good example of client-oriented approach through cultural profiling in their programme: "The local long-term residents who lived through the 1970s-1980s suffered from floods in 1984 and have shared experiences of winning a class-action lawsuit against the government's urbanization policies.Therefore, they have a strong sense of community and community pride, and this unintentionally creates a gap between them and the newly settled younger generation in the village.Drama activities that we provided allowed people to express their feelings and identity using their life-stories.Although many old residents had previously felt alienated from the village and its community programs, which seemed to them implicitly catered to younger generations, experiencing an enjoyable, self-affirming, cross-generational interaction through the storytelling program eased these anxieties."Identification of the cultural profile of the community in this case required the knowledge of the local older people's past experiences and their local history.
Another example of such an approach in Finland, given by a community artist, FP4, shows how understanding the life-history of social context and the relevant interests of the older adults aids in finding effective strategies for working with them: "I interviewed 13 baby boom generation older women and explored their 'loneliness' by investigating the hidden stories of these older women, not only their well-known roles (e.g.

, as caregivers for their families). As the participants have lived for most of their lives in a rural environment near a small town, I organized an arts-based project that combined life-stories and textile-making to integrate two of the participants' common interests. The project primarily focused on how they not only work hard as homemakers and farmers but also contribute to community politics and advancement through artistic practices."
Related examples given by the study participants demonstrated that this type of cultural profiling can be done before the programmes start and continued during their operation.Our participants stressed that the most important element of the cultural profiling process for them has been to limit the involvement of the art practitioners and officials to only inspiring the older adults in deciding all the programme details on their own.In doing so, providing a supportive and safe atmosphere has been crucial for encouraging free conversation among their programme participants.Through this process, the practitioners have been able to effectively elicit the participants' expectations and desires, as well assisting their decision-making process in subtle ways.As such, cultural profiling is seen as the primary tool in a client-oriented approach, which has ultimately allowed the participants to take ownership of their programmes, has promoted their continuous and active participation, and has boosted their self-esteem.

Artistic Creation Focussed on Fun and Play
Many of our study participants noted that their engagement techniques with older adults were generally based on mutual consent.The practitioners in both countries firmly underlined the power of play-based and fun-focussed creative activities.Such techniques were closely linked to practitioners' proficiency when interacting with older adults.This proficiency was assessed in terms of how they moderate proper activities that reflect their own interests and the type of material they choose to support older adults' effective engagement.In addition, the idea of "play" and "playfulness" was considered as being vital for the success of arts-based interventions and cultural programmes for older adults, especially since a common catalyst for older adults' participation is often to find new challenges and gain new experiences in their lives.
For instance, in South Korea, art educator KP3 emphasised the role of practitioners in terms of developing playful art-based interventions that stem from older participants' own existing fun activities: "We developed storytelling and puppetry activities using a traditional card game that older people commonly enjoy in real life with their friends.As the image of each card contains aesthetic and philosophical elements such as love, money, and hope, we intended to make it easier for older people to elicit their life experiences and stories through familiar images as reference material."This example demonstrates how creative activities could be transferred to new fields of art using a familiar form of leisure or social activity such as a card game.
Creativity in these programmes is, of course, not limited to traditional fields of art.In Finland, for example, the community artist FP4 pointed out that small simple material -even household waste -can be a valuable ingredient for encouraging playful creativity that can involve a deeper sense of meaning: "Once they had done the first arts-based project, they learned how to speak out their mind and express their feelings and thought in creative ways.They felt capable of doing something more, and we decided that in the next project we could go for something that could target nationwide problems.We collected household waste (e.g.plastic packaging) and made garments out of them for a performance to raise awareness of the environmental crisis." Our study participants noted that based on their own experiences the play-based and fun-focussed approach encourages older adults to try new things and to have more fun when they take part in creative activities for the first time.While the goals of arts-based interventions and cultural programmes for older adults can vary, depending on the socio-cultural context of each country and community, their underlying aim often remains the same: "to allow older adults to claim one of their rights as human beings by enjoying arts and culture."This means that all older adults are entitled to benefit from arts-based interventions and cultural programmes, through recognition of their artistic efforts and achievements -however small they might be -and be provided access to a variety of stimulating fun activities.

Openness and Flexibility
According to our study participants, openness and flexibility are crucial for practitioners when interacting with older adults, as means of combating pervasive stereotypes and biases towards ageing people.While openness is considered as an attitude that practitioners must adopt in treating older adults without any preconceptions, flexibility is necessary for dealing with the inevitable variables that exist when working with older adults.Commonly observed variables among older adults included, in particular, seasonal effects on their overall health, and the level of their enthusiasm for sharing their experiences and stories.These factors seemed to have a significant effect on the operation and continuity of arts-based interventions and cultural programmes.For example, the practitioners mentioned often having to modify their plans and changing the pace of their programmes by monitoring daily mental and physical state of their older adult participants.In addition, the practitioners recalled consciously trying to share opportunities for participation by making sure that all the participants speak equally, while keeping the programme on schedule.
For instance, the cultural instructor FP7 in Finland highlighted the idea of openness and flexibility based on her experience: "A key strategy for working with older adults is being brave and not too careful.Don't assume or pre-judge anything before interacting with them.Once you're engaged with them, you can see age doesn't matter.However, reading the participants' daily condition and situation is very crucial.Depending on their mood and condition, practitioners should be ready to change their planned tasks flexibly.Such flexibility is determined by how to catch subtle signs of a changing situation and how to manage such a situation successfully, taking different approaches."In this example, the instructor's professional competence in maintaining such a strategical approach is clearly invaluable.
Similarly, in South Korea, the project manager KP7 referred to openness and flexibility in working with ageing people: "The trickiest part of running our programme with older adults was that there were a lot of variables.Firstly, they wanted to talk about their stories too much, even interrupting the proceeding of daily practice.So, time management was really important, in making rules for fair participation.Secondly, long-term programs might drag participants down and make them easily exhausted at some points.So, short-term and play-based interventions were more effective at raising their interests.More importantly, having a better understanding of generational factors in planning programs for older adults must be considered from various angles."This shows that openness and flexibility is important for combating preconceptions about ageing and for responding to older adults' needs.

Theme 3: Value for Older Adults
In our study a wide range of artistic interventions resulted in valuable outcomes for older adults, not only in terms of their physical and mental health but also in their creative well-being.From the perspective of physical health, engaging in arts-based interventions is seen as supporting the healing process.For instance, the art educator FP1 in Finland described: "One of my students who had a stroke before has been greatly assisted in recovering her physical health by art-making.It helped to connect all parts of her bodybrain, vision, hand movements -when she saw details in pictures and tried to draw them by hand simultaneously."Furthermore, arts-based interventions for older adults are also seen as important for reducing their negative feelings and improve their moods through creative interactions within collective group healing processes.According to our study participants, art-making practices have helped, for example, older people deal with their grief after losing close friends by changing their moods through working with colours and imaginative activities, or making new social connections with others facing the same grief.
In addition to identifying the diverse impacts of arts-based interventions and cultural programmes on health and well-being, our study also focussed on investigating late-life creativity and how artistic engagements catalyse the potentials of creativity in later stages of life.In this regard, our study showed that having new experiences and opportunities through such interventions and programmes encouraged older adults to open new doors, explore their possibilities and go beyond existing constraints.Artistic engagements inspired discovery of creative talents and ultimately promoted the older adult participant' self-esteem, confidence, efficacy, and overall wellness through learning new ways of self-expression.Our interviewee FP5 in Finland called this "entelechy art," in referring to redefining one's own competences in older age through creativity.
Interestingly, the idea of entelechy art was identified in the South Korean context as well.In general, older people in South Korea have endured severe ordeals such as wars and economic crises.Throughout their lives, the current generation of older adults have worked hard, in order to nurture their children and look after their families.Participating in arts and culture has in the past been almost unthinkable for these older adults.Their physical suffering and repetitive work throughout their lives have, however, impacted their physical bodies, forming aesthetically skilled bodies which can be seen as creative and artistic.In other words, their aesthetic development has been shaped by, and derived from, their own life experiences.This observation was made by KP3 in South Korea: "Once they [older adult participants] started to be engaged, we could see how talented they are with embodied craft experiences.For example, when making a doll's head by cutting a large cube of sponge, they created beautiful and sophisticated sculptures, as they had been slicing things like persimmons and pumpkins in their lifelong jobs.At that point, they realized 'the years' they had been through with their body was 'art' in itself, and so started to participate in all programs with greater confidence.I saw that late-life creativity can ultimately be revealed through aesthetic experience cultivated throughout life." In addition to the qualitative interviews themselves, in this study we also reviewed empirical findings in the final reports of a few programmes in Finland and South Korea, provided to us by our study participants.For example, the arts-based programme in which FP3 was involved in Finland focussed on community engagement and social well-being of older adults.In this programme, 83% of the study participants (N 92) answered "YES" to the programme improving their well-being as a whole, 60% to it having a positive effect on their health, 86% to becoming more socially active and 88% to feeling less lonely after the programme.
Similarly, a programme in which KP6 was involved in South Korea offered storytelling-based drama activities for older adults.In a survey of this programme, 40% of the older adult participants reported that they felt more capable of expressing themselves after learning how to use arts to draw out their stories, 30% felt good about their achievements and how they were recognised by their families, 60% decided to take up new activities to further experience working with other arts, and 70% wanted to share the programme with others.All these and other surveys show, at least in a subjective sense, the positive value of art-based interventions and cultural programmes for older adults.

Theme 4: Evaluation and Reflection
The study found that evaluation processes had not yet been developed systematically in order to classify qualitative findings from arts-based interventions and cultural programmes, and there were differences between the two countries in this regard.While funding agencies in Finland did not generally require any specifically formalised evaluation criteria, most agencies in South Korea used systematic monitoring and multi-step assessment processes.
The study also identified the need to conduct qualitative assessment of the interventions and programmes by their participants.Our interviewees pointed out that the most commonly used evaluation methods included printed questionnaires and small interviews with the participants, in addition to making observations and field notes.The more traditional methods of assessments, such as the use of smiley-face surveys, are now considered outdated -not to mention ageist -for meeting the complex needs of older adults and assessing their responses.
It is interesting to note that in comparison to Finland, some feedback questionnaires used in South Korea had more specific criteria for evaluating their programmes.These criteria focussed not only on the primary aims and overall plans of a programme, and whether they had been adequately accomplished, but also on other factors such as the convenience and accessibility of the programme venue.As most funding agencies offer programmes through local cultural centres and community venues, asking about the participants' experiences and satisfaction with programme venues is considered a major factor in their evaluation.
In terms of multi-step assessment processes, the interviewees mentioned that consultation and on-site assessments were often combined in a systematic manner.Programme monitoring by advisory committees and external professionals, and consultation with them enabled thorough assessment.However, there were also inevitable criticisms about such assessment processes that were imposed by programme management.This led to practitioners being pressured to produce quantitative outcomes rather than qualitative ones.
Practitioners in both countries also reported that they had fewer opportunities to review their efforts and achievements with other practitioners in interdisciplinary settings due to a lack of standardised evaluation criteria.This issue was observed more often in cases where a practitioner worked independently as a freelancer or was hired on a short-term basis.In other words, when the evaluation was conducted only among the practitioners and participants on a case-by-case basis, it prevented a more comprehensive assessment of the results, which could be useful in establishing formally standardised evaluation guidelines for different contexts.

Theme 5: Sustainability and Networking
The study found that the sustainability of arts-based interventions and cultural programmes relied on establishing means of networking between different stakeholders.According to our study participants in both countries, genuine cooperation among the stakeholders requires active and open communication, transparency, and mutual trust.As such, the stakeholders are expected increasingly to cooperate inter-sectionally to resolve conflicts and power imbalances in order to build genuine partnerships.
Clear differences were, however, observed when comparing cultural contexts of the two countries.In Finland, teachers and art education practitioners are highly trusted professionals.This feeling of trust enables them to work effectively, with a great sense of responsibility and pride, as well as being autonomous and independent.This is highlighted, for example, by FP1: "I have a very collaborative relationship with colleagues who organize and manage all the programs at my workplace.When we work together, they only handle administrative procedures while I'm totally free to plan my courses as I like.I believe a harmonious relationship can be built between independence and dependence." In South Korea, on the other hand, a different perspective on cooperation was identified -relating to a traditional competitive cultural environment with power imbalances.In this context, while active and open communication has notable positive impacts, it is often hindered by hierarchical communication issues and inefficient bureaucracy, which in turn limits flexibility and responsiveness in programme operations.Moreover, the different social leverages and divergent views between practitioners and agencies -or sub-agencies and main funding agenciescan lead to complex interactions and relationships.In turn, practitioners and sub-agencies can become frustrated when they cannot push their creative ideas beyond structural drivers and hierarchical boundaries.
Insecure programme funding is another critical issue that threatens the development of sustainable arts-based interventions and cultural programmes.In both countries, we found that funding stability is an important factor affecting practitioners' working conditions.It follows that for effective results to be reached, the funding for these programmes should not be dictated by political agendas that sometimes shift budget allocation priorities.In reference to this issue in South Korea, KP6 commented: "As our funding organization operates on taxation, it is very difficult for us to sustain the programs and manage the budget following changing political direction every 2-4 years.This challenge also affects our programs' linear and long-term progress and completion."Despite this, the majority of the interviewees wished to sustain their programmes and continue working with their groups even after their funding period ends.In some cases, the programmes can be continued, for example, through cooperation with local community colleges, municipalities, or volunteers.

Discussion
The study reported here investigated diverse personal experiences of practitioners and professionals working with older adults in arts-based interventions and cultural programmes in South Korea and Finland.Similarities and differences in existing working methods and challenges in the two countries have been identified within the five themes of the narrative interviews of the study.
According to our study participants, arts-based interventions and cultural programmes can promote a better sense of belonging amongst older adults and increase their social engagement.Such interventions and programmes can also strengthen and foster community integration when designed to accommodate the interwoven contexts of both individuals and local socio-economic situations.Moreover, they can provide older adults with means of better understanding themselves through creative practices, and ways of working with their unconscious mind by exploring their body movements.Based on these findings, our study sheds a new light on the power of artistic and creative activities in affecting not only older adults' physical and mental health but also their social well-being.In this regard, the study highlights the need for redefining and repurposing "late-life creativity" into a new paradigm that aims to combat the prevalent deficit-oriented views of ageing.
Our study has also shown that art practitioners need to adopt a client-oriented approach which would enable them to take into account societal and cultural backgrounds of their participants, so as to provide them with more effective art-based interventions and cultural programmes.In this sense, we argue that planning tailored support for each locality can motivate and guarantee the successful operation of such interventions and programmes, and can influence the formulation of better ecologies of community support regarding care policies and services for older adults in ageing societies.This, in turn, means reaffirming the idea of collective effort towards collective impact, as discussed in this article.We would also emphasise that cultivating a shared vision and nurturing collective action are critical to the successful use of the arts for health and well-being (Daykin 2019).
In addition, our study has focussed on identifying practical approaches to fostering collective impact through collaborative relationship among diverse stakeholders, with the aim of co-creating successful arts-based interventions and cultural programmes.According to Baek et al. (2015), "[i]n design for social innovation, a collaborative community is defined as a group of people who are actively and voluntarily engaged in the collaborative production of solutions to a wide range of their own social problems, and in doing so, create a positive impact on society as a whole" (p.62).In the same vein, we propose the need for establishing a working framework for creating better provisions and supports for arts-based interventions and cultural programmes.Such a framework should be based on the main factors needed for, and effective approaches to, cooperating with older adults.Towards this goal, our study has identified five different areas -ranging from motivation and planning to sustainability and networking -which must be taken into account in developing this type of framework.If created effectively, the framework would provide structural support for co-creating arts-based interventions and cultural programmes by closely aligning them with related policies and services.This structural guiding practice will also ultimately influence the sustainability of such arts-based interventions and cultural programmes and their assessment.

Conclusion
The study presented here has highlighted the complexity of implementing and sustaining effective arts-based interventions and cultural programmes in interdisciplinary and cross-cultural contexts, and has shown the need for supporting collective efforts among diverse stakeholders involved in such interventions and programmes.
The study has also shown the need for ensuring legitimate qualitative evaluation of arts-based interventions and cultural programmes.Our study participants have highlighted that meaningful evaluation methods and criteria should be negotiated and collaboratively defined by all the stakeholders involved in provision of care services for older people at the early stages of programme planning.It is also necessary to build mutual trust in order to exchange ideas and learn from one another in an interdisciplinary and power-balanced environment, as well as across different arts-based interventions and cultural programmes.
We would, therefore, argue that it is important to consider the role and contributions of the older adult participants, practitioners, various organisations and community officials, as well as other stakeholders when co-designing and co-operating such interventions and programmes.This includes discussing planned processes, shared goals, different roles, creative mindsets, methods, and working approaches with older adults themselves.Ultimately, collaborative partnerships among different stakeholders in art-based interventions and cultural programmes can become catalysts to synergetic actions that address the interconnected and encompassing problems of an ageing society.
We recognise that our research study is limited in terms of considering all the other divergent cultural contexts that exist beyond the scope of this study.For instance, different countries clearly have their own starting points, contexts, and capacities to deal with health systems under uncertain conditions and with imperfect knowledge (WHO 2013).We would, however, expect that the empirical findings of this study are somewhat similar to working patterns and experiences across different countries and cultures.As noted earlier, we would again highlight the importance of exchanging learnings between different stakeholders in different cultural contexts.
Our future aim is to utilise the findings presented in this article to help us develop theoretical models that aim to identify the necessary factors and approaches that should be considered in designing and implementing art-based interventions and cultural programmes for older adults in an interdisciplinary environment that distributes responsibilities and encourages collaborative decision-making processes across different stakeholders.

Statement of funding
This study has not received any external funding.
local district art and cultural foundation based in the northwest of Seoul.These public foundations in each district provide different cultural and artistic contents for the residents.This foundation aims to become a local community hub with a central role in establishing arts and culture networks, especially for older adults, by cooperating with several local organisations in the same district working for community empowerment.local district art and cultural foundation based in Incheon, South Korea.This foundation aims to make art and culture a part of the daily lives of the residents, by breaking down boundaries and barriers of art and culture.range of teaching experience, spending over 20 years, especially with older adults.Offers artistic experiences using diverse art techniques in care homes, community colleges and many different places for older people.

Figure 1 .
Figure 1.An overview summary of the outcome of the thematic analysis process.

Table 1 .
A summary of the interviewed participants' backgrounds and experiences

Table 1 .
(Continued) PractitionerWorks as a practitioner in a social association focussed on memory issues based in western Finland.Focusses on the practice of socially engaged art, organising new group activities in the community, and promoting older adults' health and well-being through artistic experience.tiesfor older adults in a rural environment near a small town on the southwest coast of Finland.