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In doing so, we situate ourselves within the decolonising methodologies movement 26 and attempt to avoid imposing frameworks from the rich array of arts-based research conducted in the global north. 27 For this reason, our review is focused on the use of art in the pursuit of the World Health Organisations (WHO) widely accepted definition of health promotion, from the Ottawa Charter of 1986: health promotion is the process of enabling people to increase control over, and to improve, their health. 28 Our application of the WHO approach led us to exclude arts-based approaches to research (except when part of a health promotion effort), 29 therapy 30 and knowledge translation. 31 For, while these three traditions often overlap and intersect with health promotion, their primary aims are discreet.

Such approaches draw on deep-rooted historical traditions of indigenous groups in combination with imported traditions which emerged from colonial engagement.

To date, no review has sought to map the locations, health issues, art forms and methods documented by researchers using arts-based approaches in SSA.

Methods Using scoping review methodology, 11 databases spanning biomedicine, arts and humanities and social sciences were searched.

Papers included in the review were read and summarised using a standardised proforma.

Descriptive statistics were produced to characterise the location of the studies, art forms used or discussed, and the health issues addressed, and to determine how best to summarise the literature identified.

Results Searches identified a total of 59 794 records, which reduced to 119 after screening.

We identified literature representing 30 (62.5) of the 48 countries in the SSA region.

The majority (84.9) focused on HIVAIDS-related work, with Ebola (5.0) and malaria (3.3) also receiving attention.

Historically and as evidenced by this review, arts-based approaches have provided a platform to facilitate enquiry, achieved significant reach and in some instances supported demonstrable health-related change.

Challenges relating to content, power relations and evaluation have been reported.

Future research should focus on broadening application to other conditions, such as non-communicable diseases, and on addressing challenges raised in research to date.

No comprehensive scoping review of this work has been produced.

A rich array of approaches to using arts in support of health have been pursued in the global north, but the decolonising methodology movement suggests we should be careful not to import these into global south contexts.

What are the new findings Our review suggests that an overwhelming majority of studies have focused on HIVAIDS, and that theatre-based approaches were the most common, but music and song, visual arts, storytelling and film have received sustained attention in the research literature.

Arts-based approaches have facilitated research enquiry, reach large numbers with health-promoting messages and initiatives, and in some instances supported demonstrable health-related change.

Challenges relating to the generation and suitability of content, power relations between researchers and target community and appropriate forms of evaluation have been reported.

What do the new findings imply In SSA, arts-based approaches to health promotion have yet to be widely applied by researchers outside of HIVAIDS, suggesting that future research could develop approaches to non-communicable diseases, neglected tropical diseases and communicable diseases other than HIVAIDS.

There is great scope to develop theories of and methodologies for arts-based approaches to health in SSA that dialogue with, but do not mimic, those developed in the global north.

Introduction A long-standing critique of health promotion and intervention is that many practitioners uncritically impose categories and understandings from biomedicine on the communities with which they work.

Yet, efforts to facilitate improved health in a community are inevitably faced with the ideas, priorities and concerns that members of that community attach to health.

Failure to acknowledge, respect and work with the situated cultural positions held by community members can lead to cultural imposition, 4 introjection 5 and symbolic violence, 6 which undermine the pursuit of better health.

A range of researchers and practitioners have sought to address these problems by developing approaches to health promotion 7 inspired by action research 8 and dialogical theory.

Such approaches treat health promotion and intervention as a collaboration between community members, healthcare professionals and researchers.

One way in which researchers have pursued collaboration with communities to improve health in sub-Saharan African (SSA) is by using artistic forms.

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In SSA, creative processes have been harnessed to enquire into local experiences and understandings relating to health, 14 to intervene in drivers of health problems, 15 to provide a discreet form of therapy for a range of conditions 16 and to disseminate and validate health research findings.

These four modes have indigenous roots in African communities.

As Kerr notes, indigenous traditions such as the Gule wa Mkulu have long served as a space for moral education (eg, the dangers of excessive alcohol consumption) and the negotiation of social change in Chewa and Manganja communities.

Members of this SSA research community make the claim that artistic forms and methods facilitate participants to step outside of their everyday lives to use imagination and play to reconfigure how they understand and act on an aspect of life, such as a disease.

They also point to the importance of the potential for art to engage communities in embodied learning, 21 to stimulate empathy 22 and to provide vicarious experiences that shape collective and self-perceptions.

Building on indigenous performative traditions, arts-based methods have featured prominently in public health action across SSA.

Kamlongera points to three phases in this action: during the precolonial era, artistic expression, or folk media, was central to cultural transmission and education in many communities across Africa; during the colonial era, these folk media were often appropriated for the purposes of moral education, notably through the propaganda play and in the postcolonial era, there has been a resurgence of interest in art and folk media as media for education and development.

Of the art forms, theatre has been widely used by governments in SSA in the postcolonial era, as it is seen as a convenient instrument through which to influence health-related practices in contexts of low levels of literacy, receiving significant funding.

Using the arts for health in the postcolonial era has been most visible in responses to the HIV and AIDS epidemic.

Practitioners of theatre, song, storytelling, dancing, circus and many other artistic forms have made substantial contributions to awareness raising, prevention, testing, destigmatising and counselling initiatives.

In recent years, the Ebola epidemic has also received attention from the artistic community, notably in West Africa, which sought to communicate the danger posed by the virus and how to respond to symptoms.

While the number of studies taking such approaches to HIV and AIDS and other health issues is large, no attempt has been made to systematically map the locations, health issues, art forms and methods relating to this body of work.

In doing so, we situate ourselves within the decolonising methodologies movement 26 and attempt to avoid imposing frameworks from the rich array of arts-based research conducted in the global north.

For this reason, our review is focused on the use of art in the pursuit of the World Health Organisations (WHO) widely accepted definition of health promotion, from the Ottawa Charter of 1986: health promotion is the process of enabling people to increase control over, and to improve, their health.

Our application of the WHO approach led us to exclude arts-based approaches to research (except when part of a health promotion effort), 29 therapy 30 and knowledge translation.

For, while these three traditions often overlap and intersect with health promotion, their primary aims are discreet.

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