Qualitative research findings can be instrumentally, symbolically, or conceptually useful (Estabrooks, 1999, 2001; Sandelowski, 2004) “Instrumental utilization is the concrete application to practice of research findings that have been translated into material forms, such as clinical guidelines, care standards, appraisal tools, pathways, intervention protocols, or algorithms” (Sandelowski, 2004: p. 1371). Instrumental utilization is the goal of both qualitative and quantitative inquiry in the health sciences, and of the evidence-based practice movement that favours this form of research. Symbolic utilization is less visible and concrete, as it entails no change per se, but rather the use of research findings as a persuasive or political tool to legitimate a position or practice. Symbolic utilization may be a precursor to instrumental utilization as a change in practice may ultimately result from this form of use.
Conceptual utilization is the least tangible “as it entails no observable action at all, but rather a change in the way users think about problems, persons, or events” (Sandelowski, 2004: p. 1372). For example, the work of Gladstone, Boydell, and McKeever (2006) challenged other researchers to expand the conceptual repertoire for thinking about children’s experiences of parental mental illnesses beyond risk and resilience and to consider children’s interactions with others: how they participate in all aspects of social life, ascribe meaning to behaviour and things, and interpret how they see themselves, events, environments, and others. Such studies reflect on the potential for analyzing children’s social participation from the standpoint of child/adult interdependency and intergenerational dialogue and practice (Gladstone, 2015).
Arts-based research has made major contributions to the health sciences. It has been shown to impact health care in fields of oncology, dementia, traumatic brain injury, health disparities and homelessness, medical education, and workers’ health and compensation systems (Gray & Sinding, 2002; Sinding, Gray, Fitch & Greenberg, 2002; Gray, Fitch, Labrecque & Greenberg, 2003; Eakin & Endicott, 2006; Kontos & Naglie, 2007; Colantonio, Kontos, Gilbert, Rossiter, Gray et al., 2008; Parsons, Heus & Moravac, 2013). For instance, arts-based research – visual (painting, sketching or drawing, photography), performative (theatre, film, dance), and literary (poetry) – have made both symbolic and instrumental contributions to knowledge and practice in the health sciences. These “methods illuminate human dimensions of health and illness in ways that lower disciplinary barriers and improve our understanding of both health and social care” (Parsons & Lavery: p. 1).
Qualitative researchers turn to arts-based approaches as a way of relating to participants in order to learn about their experiences and to help them reflect on and express these experiences. Guillemin (2004), for example, uses drawings to explore the ways people understand their experiences of heart disease and menopause. Gastaldo, Rivas-Quarneti & Magalhaes (2018) use body-map storytelling to visually represent the body of participants and elicit narratives that explain how social and economic circumstances led to participants’ present experiences of health and illness. Gladstone and Stasiulis (2017) use digital storytelling to examine help-seeking narratives created by young people to foster critical reflection and facilitate expression and communication about aspects of their experience of managing everyday life when a parent has a mental health problem or diagnosed illness. With respect to knowledge translation, the performative genre of arts-based research is particularly effective in communicating health research findings because of its emotive and embodied characteristics (Rossiter, Kontos, Colantonio, Gilbert, Gray et al., 2008). It has a “uniquely compelling emotional quality, making it difficult to avoid or intellectualize the struggles and suffering portrayed” (Shapiro & Hunt, 2003: p. 923).