The art of addressing air quality: using community co-creation activities in scientific research on air pollution and public health

The multi-partner Tupumue project, which took its name from “let’s breathe” in Kiswahili, set out to understand how air pollution impacts the lung health of children in Nairobi, Kenya. Working in partnership with the children themselves and the communities in which they live, researchers used arts methods and other co-production techniques to examine asthma and other lung health impacts.

The study focused on two very different but geographically close areas in the city. Mukuru is an informal settlement, while Buruburu is a more affluent, planned residential community. Both suffer from air pollution, but from different sources – for example, burning waste in Mukuru and traffic in Buruburu.

The informal settlement of Mukuru does indeed have worse conditions for air pollution and health impacts, but both neighbourhoods suffer higher “morbidity burdens” from poor air quality – sickness and other outcomes from breathing polluted air.

The project grew from earlier research efforts in the Mukuru community that began in 2015, with work led by SEI Africa. Through those earlier research projects, building knowledge networks focused on air quality, the Mukuru community made clear that they wanted to go beyond simply building awareness of air pollution: they wanted specific research into the impact that air pollution was having on the health of those living in the neighbourhood. A partner organization in Tupumue, the Kenya Medical Research Institute (KEMRI), introduced the Buruburu community to the project.

Longstanding community engagement and collaboration with local researchers made co-producing the research a natural next step. Co-design and co-production are powerful tools for generating research at its most useful for communities: “Co-designed or co-produced science is rich, it’s inclusive and, most importantly, it’s meaningful to participants,” reflected Sarah West, co-investigator on the Tupumue project and centre director for SEI York. “For Tupumue to achieve its aims, we needed data from places that were hard to access: schools and homes. You cannot access this data and these places without solid buy-in from the communities you’re working with. You also cannot know the best and most salient research questions without speaking to those whose lived experiences you are researching.”

To maximize participation and project relevance in the the Mukuru and Buruburu communities, the team set up a series of co-creation workshops that enabled them to place participants’ needs and interests at the heart of the study. Parents, children, political representatives, community workers and more attended these workshops, which used arts-based activities to involve participants and stakeholders. Research partners from the University of Glasgow and the University of Portsmouth secured additional funding to run a large engagement programme in order to raise awareness in the two communities about the research.

During the workshops, researchers also asked children involved in the study to draw pictures under several themes: what they did out of school, pictures of any lung issues they had experienced, and what they saw on their way to school. They were asked to talk about where they felt their pictures showed clean and dirty air.

Workshops were an important part of the co-design process, helping ensure the project was inclusive and culturally relevant.

“Co-design workshops are incredibly exciting spaces: they’re noisy, energetic hubs of creativity, but they can also be fantastic grounding spaces to draw together all those involved in a research project”, West continued. “For Tupumue, we began with breathing exercises and yoga, bringing our attention to our collective breaths; we walked together through the neighbourhoods guided by community participants; we improvised theatre based on lived experiences; we explored how to introduce our project to the communities, and we enthusiastically discussed our evaluation techniques for the data.”

In this way, creative methods empowered participants to shape the project. However, the arts also played a particularly important role in communicating the project to the participants and their wider communities. During the co-creation workshops, the community recommended a “program” to maximize engagement; this led to careful thinking by communities and researchers about “when to shout and when to be subtle”, as West said. For times to “shout”, brightly coloured t-shirts, songs, murals and banners were used by community practitioners and researchers to draw attention to and create excitement around the project’s presence.

In settings where “shouting” would have been counterproductive, researchers from the University of Stirling, KEMRI and SEI conducted walking interviews with community members, prioritizing the safety of participants and fieldworkers. Using GoPro cameras to create visual reports of these walking interviews, participants took researchers to places where they felt they could breathe easily, and where they felt it was harder to breathe.

In addition to advertising the project’s presence, the co-design process also helped communicate the project’s methods to communities. A puppet show, “Billy’s Day Out”, showed the children participating how spirometry testing would take place and what it would require of them. After a pause due to the Covid-19 pandemic, “Billy’s Day Out” was reworked so that the main character, Billy, wore a mask on his way to the spirometry test.

As the research drew to a close, local filmmakers collected the project’s processes and outcomes into a half-hour video to aid dissemination. This video was presented at conferences and to the communities involved. Findings from the data gathered during the Tupumue project – from spirometry to qualitative visual journeys – have been published in two journal articles: one discussed the relationship between air pollution and respiratory symptoms; the other explored how birth characteristics impact asthma symptoms in later childhood.

Recently, Tupumue researchers reflected on the art-based aspects of the project in an episode of the “Connecting Citizens to Science” podcast. Looking to future work, they commented that the arts will help them to co-design further research to improve the lives of the participating communities and others.

As West said: “The arts are simply amazing. They empower people to ask scientific questions who would normally be unable to ask these things for any number of reasons. It’s exciting: they enrich research questions and, really, the whole research process, from what questions we ask to how we feed the answers back to the communities involved. From a co-design perspective, arts approaches help enormously with recruitment and engagement. The arts, whether visual or performance-based, were intrinsic to the success of Tupumue and will surely become a touchstone for future research by those of us involved in the project.”