Impact case study database
Changing film screening practice to bring about wellbeing benefits for the over 65s, including those living with dementia, and professional/training benefits for their carers and cultural activities providers in the UK and Brazil
1. Summary of the impact
The impact has been the creation, use and application of a downloadable ‘Cinema, Memory and Wellbeing’ (CMW) Toolkit for carers which has contributed to the strengthening of carer resilience and the development of additional skills for carers/health professionals. This has led to a change in practice regarding the use of films with the residents of nursing homes and users of day care centres and GP practices, and in hospital dementia wards (UK and/or Brazil), as well as a change in practice regarding the running of age-/dementia-friendly cinema screenings and the use of film with participants of film clubs for the socially isolated (Merseyside and Manchester). A further impact has been a positive change in the observed behaviour and wellbeing of participants in CMW activities, as well as improvements in relationships between carers and cared-for, and between the cared-for as a result of CMW activities.
2. Underpinning research
In the course of her research for the monograph on Carmen Miranda (3.2), facilitated by a Leverhulme-British Academy Senior Research Fellowship (2011), Shaw discovered that fans aged over 65 world-wide still use the star’s films and music as a way of improving their emotional wellbeing. Interviews with fans revealed how the lively music and colourful, visual spectacle in her film performances combined to engage spectators and boost their mood. In her research on the Brazilian musical film tradition called ‘chanchada’, Shaw identified the reasons for its popularity, chiefly the importance of recognisable national stars, well-known songs and comic scenes (3.1). This mix of comedy and music ensured that these films appealed to all ages and were family entertainment, and were thus widely consumed by children and adults of varied social classes and ethnic/regional backgrounds during cinema screenings in the 1950s across Brazil (given the national reach of the main producer, Atlântida studio’s exhibition circuit), as well as being re-experienced by adults who were children in the 1950s when screened on public TV channels in the 1990s and 2000s. Shaw’s research revealed the strategies used by the creators of these films to ensure that audiences identified with the characters on screen, and by extension the stars that played them (3.1 and 3.3). These strategies included incorporating tokenistic Afro-Brazilian performers alongside white stars, featuring regional accents in the dialogue and regional musical genres, and creating a parallel local star system via the Atlântida-controlled film press, that ensured these performers became ingrained in national popular consciousness.
Hallam identified the importance of memories of stars in her research on British TV series (3.5). Her research into Liverpool on screen (3.6) highlighted the existence of a wealth of images of recognisable locations and their power to trigger reminiscence. By combining their research, Shaw and Hallam were uniquely placed to devise the ‘Cinema, Memory and Wellbeing’ (CMW) project in 2014-2015, initially drawing on Shaw’s knowledge of English-language films starring Carmen Miranda and Hallam’s expertise regarding local amateur films and feature films set in Liverpool during the 1950s and 60s. Funded by an International Knowledge Exchange Voucher [University of Liverpool – UoL] the North West Film Archive produced bespoke DVDs of carefully selected clips of Liverpool and subsequently Manchester. Shaw extended the project to Brazil, using her knowledge of ‘chanchada’ comedies and Carmen Miranda’s Hollywood films that were screened in Brazil. Shaw and Hallam conducted research into the wellbeing benefits for audience members aged over 65 of group screenings of short sequences of these films combined with interactive discussions stimulated by verbal and visual prompts, in nursing homes and day care centres on Merseyside, and in a GP practice in the city of Petrópolis, Brazil. Advised by colleagues in the School of Psychology, they assessed the effectiveness of wellbeing measurement tools by implementing them into pilot studies (2015-2017), analysing the results and studying the relative effectiveness of different types of film material in stimulating group reminiscence and in turn producing emotional wellbeing benefits. Interviews with participants and carers/healthcare professionals in a variety of contexts were analysed, leading to unexpected results of self-reported improvements in staff morale and team spirit, as well as emotional wellbeing/resilience benefits for carers. Shaw and Hallam drew on the results of this research to create the ‘Cinema, Memory and Wellbeing’ Toolkit (3.4), in English and in Portuguese, documenting evidence of different kinds of wellbeing benefits resulting from this project, as well as practical advice for those running such activities. In 2018, funded by an ODA Seed Fund award (UoL), Shaw implemented the Toolkit during a 4-week CMW Film Club at the São João de Deus nursing home (Itaipava, Petrópolis), a centre of excellence for dementia care, conducting research into its effectiveness for older adults with dementia. She received an Industrial Strategy Challenge Fund award (UoL) in 2018 to test digital music- and image-related reminiscence tools with older adults, people with dementia and carers. The research funded by both awards is published in a book written with colleagues from UoL’s Music Department (3.4).
3. References to the research
3.1 Lisa Shaw and Stephanie Dennison (co-authors), Brazilian National Cinema (London: Routledge, 2007). DOI https://doi.org/10.4324/9780203755037
3.2 Lisa Shaw, Carmen Miranda (London and New York: British Film Institute/Palgrave Macmillan, 2013). Available from the University on request.
3.3 Tim Bergfelder, Lisa Shaw and João Luiz Vieira (eds), Stars and Stardom in Brazilian Cinema (London and Oxford: Berghahn, 2017). Co-authored Introduction by Shaw and Bergfelder, pp. 1-22; and chapter by Shaw ‘ Cinelândia magazine and the creation of home-grown movie stars in the 1950s’, pp. 93-110. Available from the University on request.
3.4 Julia Hallam and Lisa Shaw (eds), Movies, Music and Memories: Tools for Wellbeing in Later Life (Emerald, 2020). This is accompanied by an electronic copy of the CMW Toolkit. Available from the University on request.
3.5 Julia Hallam, ‘Remembering Butterflies: The Comic Art of Housework’ in S. Lacey and J. Bignell (eds.) Popular Television Drama: Critical Perspectives (Manchester: Manchester University Press, 2005), pp. 34-50. Available from the University on request.
3.6 Julia Hallam, ‘Mapping the “City” Film 1930-1980’, in Hallam, J., and L. Roberts. (eds.) Locating the Moving Image: New Approaches to Film and Place (Bloomington: Indiana University Press, 2013), pp. 173-196. Available from the University on request.
4. Details of the impact
Research by Shaw on film star Carmen Miranda and the ‘chanchada’ tradition in Brazilian cinema, particularly her explorations of the reasons for the enduring appeal of, and potential wellbeing benefits of group watching of both, and research by Hallam on the history of film culture in Liverpool, have directly inspired the creation, use and application of the downloadable ‘Cinema, Memory and Wellbeing’ (CMW) Toolkit for carers (available in English and Portuguese) which has been widely adopted in the UK and Brazil. The Toolkit’s methodology, refined over a series of pilot projects in both countries involving Rowan Garth BUPA care home, Liverpool (25 residents), the Fazenda Inglesa GP practice, Petrópolis, Rio de Janeiro state, Brazil (68 older adult users), and Company Matters4U day care centre, Liverpool (60 older adult users), and related training provision devised and delivered by Shaw, have contributed to the strengthening of carer resilience and the development of additional skills for carers/health professionals. This has led to significant changes in practice regarding the use of films with the residents of nursing homes and users of day care centres and GP practices (Merseyside and Brazil), as well as changes in practice regarding the running of age-/dementia-friendly cinema screenings and the use of film with participants of film clubs for the socially isolated (Merseyside and Manchester) and patients on NHS dementia wards (Greater Manchester). A further impact of adoption of the Toolkit methodology, rooted in Shaw and Hallam’s respective research on film/TV audiences and their collaborative research on how audio-visual stimuli can be best used as a reminiscence tool among older adults and those living with dementia, has been a positive change in the observed behaviour and wellbeing of participants in CMW activities, as well as improvements in relationships between carers and cared-for, and between the cared-for.
In 2018 Shaw implemented the Toolkit during a 4-week CMW Film Club at the Lar São João de Deus nursing home in Itaipava, Petrópolis, a centre of excellence for dementia care, conducting parallel research into its effectiveness for those living with dementia. This involved 33 participants (18 residents, 5 of whom had a dementia diagnosis and 2 others with cognitive impairments of different kinds; and 15 older adults from the local community who attend the home’s day care centre). The Toolkit/methodology has since been adopted by care homes, individual carers (paid and unpaid), charities, cultural institutions and health care providers in the UK and Brazil, leading to positive changes for older adults, the socially isolated (particularly during the Covid-19 lockdown), those living with dementia and their carers. (Adopters in Brazil: 6 community health workers [ACSs] at Fazenda Inglesa GP practice; 4 care staff at Lar SJdD; 38 carers/health workers who attended Toolkit training at Museu da Imagem e do Som [MIS], Campinas; Adopters in the UK: 8 staff at Company Matters4U day care centres and Rowan Garth care home; 12 volunteers at Alzheimer’s Society [Sefton, 29.1.2020]; 12 unpaid carers; 25 attendees of Toolkit training at the Plaza Community Cinema [13% family carers; 20% from community charities; 47% from residential care homes; 20% NHS employees]; 14 Manchester versions of the Toolkit used in NHS hospital dementia wards/ day care centres in 11.2020).
The adoption of the Toolkit methodology has strengthened carers’ resilience and sense of worth in their role and developed additional skills and provided cost-effective resources and tools for carers/health professionals. A community health worker ( agente comunitário de saúde - ACS) at the Fazenda Inglesa GP practice (Ana Beatriz Renter, questionnaire, 10.10.2017, 5.1) said: “I was actually thinking of leaving the profession but after the event I had second thoughts, as I realised my job was worthwhile and that I was needed. I felt more valued. In our team we became closer afterwards, even with difficult colleagues.” Another ACS (Zélia Sousa, video testimony transcript, 1.7.2015, 5.1) said: “It gave me more motivation, I had more desire to work. You gave us more ideas.” A speech and language therapist who used the Toolkit with people with dementia in the UK said: “It was a positive experience for staff to discuss people’s experiences relating to the film footage – helping to see the depth and complexity of people’s lives.” She gave the following example: “Conversations with one resident led to discussions about their time living in South Africa which was particularly interesting. Interesting subjects and stories like this can help build relationships between staff and patients and to get better insight into the lives that people have lived” (Ellen McGowan, Pennine Care NHS Foundation Trust, 16.12.2020, 5.8). Claire Marrett (Together Dementia Support) added: “I have been able to use it to ‘fill in the gaps’ where I have known some of the life history of people but have not had the tools to help them elaborate on talking about this time in this [sic] life” (16.12.2020, 5.8).
CMW events and the Toolkit led to significant changes in working practices. The Fazenda Inglesa GP practice in Brazil now runs a social group specifically for older people focused on conversation and reminiscence, and the ACSs have chosen to do further training to work with older adults. (Zélia Sousa questionnaire 25.11.2019, 5.1). Eleanor O’Hanlon, managing director of the Company Matters4U day care centres in Liverpool confirmed that her “staff have mirrored techniques used at the [CMW] event (to encourage people to join in).” ( 5.3) A carer at Waterloo Park Day Centre, Merseyside said: “Since using the Toolkit we have changed the way that we have been doing reminiscence groups. We have ensured that we only use smaller clips […] so people who are living with dementia can retain the information easier, don’t get as distracted.” (video testimony of care assistant Leah Rossindale, 5.2) 100% of the attendees at the Toolkit training at the Plaza Community Cinema reported that they would change their current practice in response to the Toolkit, and incorporate additional activities suggested in it. (67% said they would now use the short clip + interactive break format; 67% would combine archive footage with music; and 67% would incorporate group discussions into film events.) 12 months after the training, changes had been embedded at Sefton New Directions adult care services, as confirmed by care assistant Frances Deaves: “After we were invited to join you last October at your cinema, memory and wellbeing event […], we took away some really useful tips and used the tool kit to enhance our reminiscence activities. We recreated our TV lounge to look more like a cinema with rows of comfy chairs and dimmed lights. We shortened the time that we screened a film into two halves with a drink and a snack in between as we realized a full film can be too long for those living with dementia to concentrate on.” ( 5.6). Of the attendees at the Toolkit training at the MIS-Campinas, 55% declared that they would make a change in response to the Toolkit; 51% would make a change to what activities they offer and how they offer them; 21% noted significant changes that they would make to their current practice (e.g. changing how films are introduced, giving older adults the opportunity to talk about feelings in relation to cinematic memories); and 30% who had never used film in their current settings planned to introduce film activities through use of the Toolkit. Brazilian care home psychologist Marly de Souza Galvão stated: “I work with old people and I would like to take back to my team this activity to be carried out in our institution. […] I am in charge of a home for 21 old people and I am going to introduce this project there because it will undoubtedly be very good for the home.” ( 5.7) An NHS occupational therapist (OT) who used the Toolkit with dementia inpatients said that the format of the CMW session also made him and his colleagues consider new ways of focussing purely on group reminiscence rather than weaving elements of reminiscence into other group activities like baking, adding that “having used the CMW concept it has prompted us to consider focussing on regular Reminiscent [sic] groups” (Shaun Dorrington, email, 15.12.2020, 5.8).
The CMW project and Toolkit have also changed how cinemas/cultural institutions embed age-/dementia-friendly film screenings into their activities. According to Community Engagement Manager of the Plaza Community Cinema in Crosby, Merseyside (video testimony of Christine Physick, 5.2): “Before working on this project I’d wanted […] to include some creativity [to dementia-friendly screenings] with the groups, rather than people just coming to watch a film […] so that for me would be the lesson or learning I’ve taken from this […] We would be looking at doing a lot more creative, arts-based projects […] with a view to linking it to some of the films.” Planned CMW events for socially isolated older people in partnership with the charities Liverpool Cares and Manchester Cares were replaced during the Covid-19 lockdown with a CMW Facebook page ( https://www.facebook.com/pg/cinemamemoryandwellbeing) featuring weekly posts of a variety of short film clips and weekly live Zoom ‘social clubs’ based on the CMW model, involving on average 15-20 participants. Manchester Cares will adopt the CMW methodology when it resumes its face-to-face film clubs. Heather Madden (Social Clubs Coordinator, testimony 13.7.2020, 5.5) stated: “Going forward I intend to use the CMW method in a variety of ways. Firstly, I will do some social clubs that feature documentary shorts all on a particular theme. I will then have shorter discussions in between each short […] On evenings when I do have feature length documentaries, I will try to plan it in a way that allows for several pauses for reflection and shorter discussions at points during the film instead of just one big discussion at the end.” The Facebook page further engaged members of the public (as of 31.12.2020: 342 followers;) and a Portuguese-language version was created in partnership with the Museum of Image and Sound (MIS-Campinas) (as of 31.12.2020: 365 followers).
CMW events and the Toolkit have led to a positive change in observed behaviour and wellbeing of older adult participants, including those living with dementia; Eleanor O’Hanlon of Company Matters4U day care centre noted that “after the event a few of the more shy [sic] males were more confident in joining in with activities […] A lady who previously wouldn’t sing on the microphone on the karaoke (afternoon) now joins in with gusto.” (13.11.2017, 5.3) The CMW methodology (short clip format + interaction/ discussion) had the following effect on participants in Manchester Cares social clubs, as Heather Madden (Social Clubs Coordinator) stated: “I have noticed a positive change in the way people interact at the weekly CMW chats compared to how they are at face-to-face screenings of longer films. The key positive change I have noticed is around the content of conversation. Generally, at face to face film nights people will spend a lot of time ‘catching up’, talking about their days/weeks or upcoming plans. During the weekly zoom chats there has been a lot more in-depth and personal discussions.” (testimony 13.7.2020, 5.5). Abbie Beckett (Social Clubs Coordinator at Liverpool Cares) said that the CMW methodology “has definitely changed the way that I will run social clubs going forward. I think there’s a real want for the CMW clubs to continue in some way face-to-face after lockdown is over, and neighbours love watching the short video clips to both bring back memories and discuss with their friends.” ( 5.5). An NHS occupational therapist who used the CMW Toolkit with dementia inpatients stated that “Occupational therapy assistants (OTAs) report that seeing their patients’ therapeutic engagement and pleasure they gained from watching the clips was very moving”, adding that the use of the Toolkit “created group discussion, was thought provoking and had a positive impact on patient wellbeing. One particular patient’s mood was elevated positively after the group, from his pre-occupied state before the group” (Shaun Dorrington, email questionnaire, 15.12.2020, 5.8). Jo Davies, manager of a day centre for people with dementia, said of her experience of using the CMW method: “it brought out many memories and conversations to clients who normally sat back and listened rather than taking part […] By giving them time in smaller groups or a one to one they blossomed” (email, 15.12.2020, 5.8). After using the Toolkit with dementia inpatients, speech and language therapist Ellen McGowan said: “One particular benefit was it being a good distraction for a patient who was agitated on the ward and repeatedly asking to go to bed – [he] got engaged with the film and started talking about his university days at Manchester”. She added that its use “[r]educed agitation, increased activity, got people communicating with each other” (16.12.2020, 5.8) .
Use of the Toolkit in organising film events led to an improvement in the relationship between carers and cared-for, and between the cared-for. One of the ACSs at the GP practice in Brazil (Ana Beatriz Renter questionnaire 10.10.2017, 5.1) said that “My view of the old people changed – I discovered that they need more attention, company, affection, more activities specifically for them. […] Before the public had a more formal relationship with us (health workers) – but after seeing us in fancy dress they are now more at ease with us, more willing to talk and open up to us. It has helped break down barriers between us and the patients. They now invite all of us (ACSs) to go into their home (before the event they wouldn’t let us in, and we dealt with them on the doorstep)”. This improved relationship has continued, as confirmed by the same ACS in a testimony of 25.11.2019 ( 5.1): “Thanks to the work Lisa [Shaw] did here at the health centre and her help, the health team learned how to care more for the old people, give them more attention, and actively seek them out, making the old people more interested in events like this one (the film event), they participated more and were happier. This would not have happened without Lisa’s cinema project and her research in this area.” The newly arrived resident priest at the dementia nursing home in Brazil, which also runs a free day care centre for older adults who live locally, noted how the project broke down barriers between the two groups, providing a focus (film clips and the reminiscences triggered) that enabled them to identify with each other and find something in common: “The ones from outside the home, who are more agile, approached those in wheelchairs [residents], they all came together, there was no division […] they helped each other.” He continued: “It [the CMW Film Club) gives value to their [the older adults’] lives as they are. They are people with a history. They can feel that today, for us, the history they have lived through in the past continues to be important. That has made a big difference to them. It has been very useful for me, enabling me to create closer links with them.” (Padre Guilherme, audio testimony 1.8.2018, 5.4). The impact of the CMW project was recognised by Shaw’s shortlisting for an AHRC/Wellcome Trust Medical Humanities Award for Best International Research (2020).
5. Sources to corroborate the impact
5.1. Two testimonies from Zélia Sousa, ACS at the Fazenda Inglesa GP practice, Petrópolis, Rio de Janeiro state, Brazil (video testimony on 1.7.2015 and written testimony on 25.11.2019) + questionnaire completed by Ana Beatriz Renter (also ACS at the practice) on 10.10.2017 + written testimony from Ana Beatriz Renter on 25.11.2019.
5.2. Short film containing edited testimonies from care assistants (Leah Rossindale and Janet Moorehouse) and Christine Physick (Community Engagement manager, Plaza Community Cinema, Crosby, Merseyside) about “Cinema, Memory and Wellbeing Festival” at the Plaza Community Cinema, September-October 2019. (17.10.2019).
5.3. Questionnaire completed by Eleanor O’Hanlon, managing director of Company Matters4U day care centres in Liverpool (13.11.2017).
5.4. Audio interview testimony with resident priest, Padre Guilherme, Lar São João de Deus nursing home, Itaipava, Petrópolis, Rio de Janeiro state, Brazil. (3.9.2018).
5.5. Testimony from Heather Madden (Social Clubs Coordinator, Manchester Cares, 13.7.2020) and testimony from Abbie Beckett (Social Clubs Coordinator, Liverpool Cares, 15.10.2020).
5.6 Testimony from Frances Deaves, care assistant at adult social care provider Sefton New Directions (https://ndirections.co.uk/\) 12 months after attending Toolkit training at Plaza Community Cinema workshop (13.10.2020).
5.7 Feedback from Marly de Souza Galvão, psychologist at São Vicente de Paulo (ILPIP) care home, Campinas, Brazil, and other attendees at Toolkit workshop at Museum of Image and Sound (MIS), Campinas, São Paulo state, Brazil (5.12.2019).
5.8 Feedback in the form of short questionnaire answers supplied via email from various users of CMW Toolkit with NHS inpatient dementia wards or day care dementia services (12.2020).
Additional contextual information
Grant funding
Grant number | Value of grant |
---|---|
SF100022 | £39,286 |