The Pinnaroo Project: a longitudinal 3-year cross-sectional study of the impact of a community-based arts-in-health program on the health and wellbeing of a remote Australian community

Robyn Clark; Jeffrey Fuller; Aarti Gulyani; Debrah F Cowill; Julie Wallis; Rebecca R Niejalke; Maz C McGann; Morrison  Polkinghorne; Dianne Thornton; Mathew P Wallen; John Denton; Stuart B Cassidy; Julia  Romano; Igor Ferreira; Edbert E Lim; Narmon S Tulsi; Barry J Burgan; Alison L Kitson; The Pinnaroo Project Team

doi:10.22605/RRH9893

Original Research

The Pinnaroo Project: a longitudinal 3-year cross-sectional study of the impact of a community-based arts-in-health program on the health and wellbeing of a remote Australian community

AUTHORS

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Robyn Clark¹ PhD, Matthew Flinders Emeritus Professor and Flinders University Distinguished Alumni *

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Jeffrey Fuller¹ PhD, Professor (Primary Health Care)

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Aarti Gulyani ¹ MSc

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Debrah F Cowill² PhD, Co-chair

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Julie Wallis ² DipBThpy

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Rebecca R Niejalke² GradCertNurs

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Maz C McGann^2,3 BA

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Morrison Polkinghorne²

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Dianne Thornton² MNursPrac

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Mathew P Wallen¹ PhD

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John Denton⁴ GradCertMan

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Stuart B Cassidy⁴ BLabMed

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Julia Romano⁴ BMedSc

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Igor Ferreira⁴ MSc

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Edbert E Lim⁴ BSc

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Narmon S Tulsi⁵ Partnerships Engagement and Research Manager

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Barry J Burgan⁶ BEcon, Honorary Adjunct Professor

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Alison L Kitson⁷ PhD, Professor

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The Pinnaroo Project Team

AFFILIATIONS

¹ Caring Futures Institute, College of Nursing & Health Sciences, Flinders University, Adelaide, SA, Australia

² The Pinnaroo Project, Pinnaroo, SA, Australia

³ Play Your Part, Tanunda, SA, Australia

⁴ Integrated Cardiovascular Clinical Network SA, SA Health, Adelaide, SA, Australia

⁵ Global Arts & Health Alliance

⁶ Bond Business School, Bond University, Robina, Qld, Australia

⁷ School of Nursing, University of Sydney, Sydney, NSW, Australia

ACCEPTED: 16 March 2026

Early Abstract:

Background: Rural and remote communities around the world face limited access to health and other services, often in the context of social, political, economic and environmental adversities. Evidence from The World Health Organization (WHO) recognizes art as a vital, non-invasive tool to enhance physical and mental health. The Pinnaroo Project was an arts-in-health project established by a remote rural community to address a dearth of locally available health services.

Methods: This study utilised a longitudinal three-year cross-sectional study design from 2021 to 2023. The Pinnaroo Project team partnered with experts in creative art and Flinders University, who measured health outcomes during the evaluation period. All Data were collected was from community volunteers.

Results: The Pinnaroo project developed more than 57 creative art experiences in 110 workshops, with high satisfaction (90%) reported from 616 feedback forms. During the 3-year evaluation period, there was a total of 564 health screenings with 66% (122 out of 186 participants in 2023) and 75% (126 out of 167 participants in 2022) reporting engagement in arts activities. Participation differed by gender, with higher engagement among females (64%; p<0.001). In the adults who participated in the arts, there was a significant reduction in self reported depression (PHQ≥5, dropping from 31% in 2022 to 19% in 2023 (p=0.03) compared to no-art (36% to 30%; p=0.53) In multivariable analyses after adjusting for demographic and clinical characteristics, arts participation was associated with a 62% lower likelihood of depression compared with non-participation (OR=0.38, 95%CI: 0.19, 0.79; p=0.01) Among children, a trend towards increased reported mental health difficulties was observed in arts participants; however, there was a 91% participation rate in the art activities among the local children making the non-arts comparison group too small (n=6) for comparison. Arts participants were 1.7 and 1.07 times more likely to meet recommended vegetable and fruit intake respectively. Smoking prevalence was lower and fewer had elevated blood glucose levels. Quality of life scores were higher among arts participants compared with non-participants. The economic modeling indicated there was a $2.30 return on investment for every dollar invested in this initiative.

Conclusion: The Pinnaroo Project demonstrated the success of rural communities leveraging alternative creative approaches to support population health, while developing a scalable evaluation model for implementation in similar settings. For every dollar spent on this project there was a $2.30 return on investment to the community economics which incentivises continuing investment.

Keywords: arts-in-health, community led primary care, economic outcomes, rural health.