“I can’t see how people could walk through that exhibit and not be forever changed”: A qualitative analysis exploring the use of art in research dissemination

Background: Art can be a strong advocacy tool; it can be used to amplify the voices of marginalized communities and can change people’s perceptions of the world and others in it. In 2018, an art exhibit at Jefferson University included the cardboard signs of people who panhandle in Philadelphia as well as excerpts from in-depth interviews with those who panhandle to highlight their lived experiences. While the team published an article about this work, the purpose of this follow-up study is to explore the lasting impact of the exhibit experience on attendees’ perceptions of people who panhandle.

Methods: Fourteen attendees of the “Signs of Humanity” exhibit were interviewed 18 months later to explore their recollection of their visit and perceptions of the panhandling community. Interviews were recorded, transcribed, and thematic codes were developed in two ways: a priori codes based on literature, and through line-by-line reading of transcripts.

Results: Directed content analysis showed three main areas in which the exhibit resonated with participants: emotional, behavioral, and educational resonance, in addition to a cross-cutting “sticky” theme, referring to the memorable long-term value of the exhibit.

Conclusion: This study demonstrates that integrating art into the dissemination phase of research is effective in imbuing long-lasting emotional/behavioral responses in a way that is both accessible and provocative for the lay and scientific communities. This study adds to the body of evidence supporting the efficacy of art as an education tool and supports its use as a way to amplify the voices of marginalized communities.

Introduction

Art can be used to amplify the voices of marginalized communities and can change people’s perceptions of the world and others in it. Arts-informed research, specifically art as a tool for research dissemination, has been used in the past to give voices to underrepresented communities both within and outside of the healthcare space (Lapum et al., 2014; Guruge et al., 2015; Rice et al., 2015; Barry, 2017; Tate et al., 2022). One of the many strengths of this method of research dissemination is its ability to effectively present findings in ways that are powerful, thought-provoking, and accessible to both lay and scientific audiences (Lapum et al., 2014).

In a prior study, we deployed this approach to amplify the voices of people who panhandle, defined as the act of seeking financial support or help from a passerby (Barry, 2017; Tate et al., 2022). While not all people who panhandle experience homelessness, these terms are often used interchangeably (Barry, 2017; Tate et al., 2022). There is substantial prejudice and misunderstanding towards those who panhandle (Lapum et al., 2014) with only 59% of people believing people have the right to panhandle in public spaces (Guruge et al., 2015). In many US cities, panhandling is one of the main ways in which those who are housed and unhoused interact, and as such, this interaction is a prime opportunity for reducing stigma toward those who panhandle. Though there are studies that explore homelessness from the perspectives of the unhoused and domiciled (3; 5), we were unable to find any papers that addressed the use of art in this context.

In 2018, researchers (including the PI of this study) at Thomas Jefferson University conducted a qualitative study, exploring the lived experiences of those who panhandle in Philadelphia (Lankenau, 1999). Briefly, working with artist Willie Baronet, the team conducted one-on-one interviews with those panhandling on the street in Philadelphia, and the results of this study were presented in concert with an art exhibit called “Signs of Humanity,” in which the cardboard signs purchased from people who panhandle were displayed. In addition, there was a panel discussion with the team and two people who were formerly unhoused. The purpose of this follow-up study is to explore the impact of the aforementioned exhibit experience on attendees’ perceptions of people who panhandle, and in doing so, to add to the body of evidence demonstrating the efficacy of art as a research dissemination tool. This was not part of the 2018 study plan; however, response to the exhibit sparked the investigation presented here.

Materials and methods

Study overview

This study was approved by our institutional review board and follows Consolidated criteria for reporting qualitative research (COREQ) (Lee and Farrell, 2003). Details of the original art exhibit and research project are fully described in a previous publication (Lankenau, 1999). The Signs of Humanity art exhibit and panel discussion were held in the fall of 2018. While not part of the original study design, the team was inspired to conduct follow-up interviews with attendees after receiving dozens of calls and emails from people who felt “moved,” and “changed” by their visit to the exhibit.

Data collection

Of the over 200 visitors, 14 participants were interviewed approximately 18 months later (February to April 2021). As is common in qualitative work, we used a constant comparison approach, to determine coding saturation and sample size (i.e., later interviews did not elicit new information relative to earlier interviews so recruitment was stopped; Boddy, 2016). A convenience sample was recruited from emails shared in the exhibit’s guestbook and from people who had reached out to the study PI to share reflections. All participants consented to be interviewed via a video conferencing platform by an experienced interviewer (CD). Each interview lasted approximately 15–30 min. Using an interview guide (Appendix A), semi-structured interviews focused on understanding participants’ memories of the exhibit, the changes in perspective or behaviors towards people who panhandle that persisted after this time, and their perspectives on art as an education tool. Interviews were transcribed and identified by two members of the research team (SK, CS).

Codebook development

For this directed-content analysis, the team collectively developed thematic codes were developed in two ways: (1) a priori, informed by the literature (2) line-by-line reading of all 14 transcripts (Hodgetts et al., 2011). All codes were given explicit definition to improve intercoder reliability. All coding was completed on NVivo 12 Software (QSR International). Four team members (VP, AS, MP, AH) coded the transcripts using a team coding approach; that is, VP and AS met and coded half of the transcripts, resolving discrepancies in real-time, as did MP and AH. Any unresolved discrepancies were brought back to the larger group for resolution. The study team then drafted code summaries and identified exemplar quotes that most represented participant responses. The codes were then organized into thematic categories. All data collection, codebook development, coding, and thematic analysis were overseen by a qualitative-research methodologist, with over 20 years of experience (RF).

Results

Study demographics

The 14 people who attended the Signs of Humanity art exhibit were interviewed, 8 were women, 11 identified as white, 2 as black, and 1 as Asian. Respondents were members of the lay and scientific community. Resultant codes were organized into 4 thematic categories to inform the development of an explanatory model: emotional resonance, behavioral resonance, educational resonance, and sticky (Supplementary Figure 1). The themes and subthemes are described below, supported by exemplar quotations from participants.

Emotional resonance

The first, emotional resonance, is a theme that describes how the exhibit affected their sentiment towards those who panhandle. This thematic category was subdivided into humanity, feeling, and empathy, where participants discussed their newfound ability to see people who panhandle as humans, their emotional reaction to attending the exhibit, and their ability to imagine the lived experiences of those who panhandle, respectively.

Humanity

Participants stated that the exhibit evoked feelings of humanity that are often missing or not extended to the panhandling community. Some respondents reported that it helped open their eyes and view the individual as more than just discarded human beings.

“But it really opened my eyes to see, to get a little glimpse of them, you know about them, and it really impressed me, you know the messages they were sending, their humanity, their sensitivity, it really gave me a new insight into who they were. They weren’t just these people sitting on a sidewalk, you know, they were human beings, you know.”

“The experience overall just was a good reminder that people experiencing homelessness are still people, and they still deserve to have dignity and humanity and be treated with respect.”

Feeling

Participants stated the exhibit evoked powerful emotional responses in them. The artistic format and its unique use of pathos were cited as major contributors to the exhibit’s impact, particularly when compared to a more traditional lecture format. Participants described the exhibit as touching, overwhelming, and saddening. Others noted that the signs demonstrated the wisdom, humor, and resilience of their authors. One participant shared:

“Yeah. I think it really broke a barrier, I think, because of discomfort, misunderstanding, and not really knowing what to do. It’s natural to have a barrier where you don’t really look at them, at people on the street, and I think it broke that barrier so that now I look at them; and, of course, I feel sadness and all of that for their plight, but I don’t have a barrier that stops me from seeing them as human.”

Empathy

Participants shared that the signs promoted empathy and helped them not just sympathize with those who panhandle but identify with their experiences. Additionally, participants explained that the signs helped them realize that anyone could end up in this position. One participant shared:

“[I] read them and then internalized them, and it’s like “how would I feel?” or like what are all the things, this is often something that I think, right like what are all the things that would have to happen in my life for that to be like where you end up … For a lot of people it’s not that many things that need to happen, and I feel like you read the signs and you start to feel it, it’s like oh like this person you know was in the army, or this person was a nurse, or this person you know had like similar aspirations and even jobs in some ways to the people who were in the room, and still they’re making a sign, so you also felt an interesting connection with what the sign said and you felt, seems like this could be me if a couple, you know, wrong turns happen along the way.”

Behavioral resonance

The second theme, behavioral resonance, describes how the exhibit affected participants’ behaviors towards those who panhandle. This thematic category was subdivided into efficacy, changed outlook, and changed behavior. Participants shared how the exhibit helped them reflect on their current behaviors and change these behaviors or perspectives towards people who panhandle.

Efficacy

Participants felt that the exhibit was useful in provoking larger questions about panhandling and how it impacts the individuals. Participants also mentioned the impact the exhibit had on themselves, noting the value of the experience on their view of people who panhandling.

“It’s that experience that brings about the neurocognitive emotional response that you don’t always get just by reading a document or looking at a newsfeed or even seeing it on T.V.—it seems further removed; but when you’re present and walking through it, it’s an amazing realization.”

Changed outlook

Participants detailed several changes in outlook in response to attending the Signs of Humanity exhibit. Some participants mentioned more subtle changes in their perspectives, such as making them more appreciative of what they have and being more open to helping others they may encounter who are panhandling. Others mentioned that the exhibit was powerful and prompted participants to encourage others to visit. In short, participants were more likely to help others, as one participant stated, “I think I’m at a place where I’m open to changing my viewpoint.”

“They’re not just somebody who opted to roll out onto the street and give up on life—these are really, really resilient people fighting for their spot on the corner, you know, trying to make their way into a shelter, keeping themselves safe, you know, working all the angles that they could. So, it was very insightful.”

Changed behavior

Participants endorsed several behavioral changes in response to attending the Signs of Humanity exhibit. Some participants mentioned smaller changes in their interactions with those experiencing homelessness on the streets, such as increased eye contact, smiling, brief exchanges or greetings, and reading their signs more closely than before. Others mentioned that they are more likely to offer money or purchase extra food for whoever was panhandling outside of a restaurant or grocery store. A few participants created “blessing bags” that they would carry with them and distribute along their way to work to anyone panhandling. In short, participants were more likely to, as one participant stated, “engage in more humane interactions with homeless people after the exhibit.”

"More often I acknowledge the position that I’m in, in that I do have something, I may not have a ton, I may not be able to do what the wealthy should be able to do or to be willing to do, but I can do something, and I think even if it’s a smile um or sometimes just if I’m going to grocery store getting food, um I’ll stop sometimes and just ask someone, hey, I’m going to the grocery store, would you like some fruit or a granola bar, um you know those types of things, small, but I think helpful."

Educational resonance

The third, educational resonance, is a theme that describes how the exhibit delivered an educational and art-informed framework towards those who panhandle. This thematic category was subdivided into art as a tool, Art, Education, Installation/medium, and Signs vs. Panel. Participants shared how the exhibit helped create a relationship between art and research to help convey the exhibit in a more non-traditional approach.

Installation/medium

Participants stated that using the raw materials, such as cardboard or plastic bags, from people who panhandle on the street was distinctly different from other art exhibits they had been to in the past and “gave them exceptional power.” They also reported that removing the signs from their original environments and having so many signs together in one place forced attendees to pay attention to the issue differently. Other participants shared that the way the exhibit displayed the signs was unique, memorable, and had a surrounding effect. One participant shared:

“And, the fact that they were on such, you know, that they were on the cardboard from various boxes and shoeboxes and things I thought was very powerful. The metal hangers that were used were symbolic to me of, you know, the simplicity of, how ironic that people who do not have a home, you know, you are putting their signs on hangers that they do not have because they do not have a closet, because they do not have a house. You know, and then the juxtaposition of where the signs were, where Willie [the artist and team] got them, were, you know, that they were, they, usually if a homeless person is either sitting, standing up or sitting down with a sign, right? And yet these you had to look up at, which I found very effective, I thought that whole thing of, you know, you are looking up at something rather than looking down on.”

Education

Participants reported that there was an educational value to attending the exhibit. One participant shared:

“It was educational in just—in its humanity, in being able to actually read the messaging; it’s not all the same. I mean—you know—people are homeless for all different reasons, right? And so, how they communicate their need is as varied as the reasons they find themselves in the predicament, and so it was an unbelievable representation.”

Art

Respondents discussed the artistic nature of the individual signs and as a collective exhibit. Though most participants acknowledged the impact of the art exhibit, many debated whether the signs are truly art, a form of communication, or both.

“Although I’m not sure that all of the people that write their signs think of it as art; as a way to communicate, but what the exhibit is trying to do is to translate for people that used it as a means of communication.”

“And it was the beautiful colors that really, really struck me, and it says ‘homeless, anything helps.’ And to me, … the words in it … didn’t affect me as much as the colorful sign and the beautiful artwork.”

Art as a tool

Respondents found art to hold significance and meaning by addressing and showcasing complex public health issues in a way that is more approachable. “And, you know, art is a way of communicating to people, and putting stuff in a different context may make it more acceptable to some people” Others mentioned that art here is used respectfully as a tool to reach people beyond academia. It is a mechanism that extends past the standard approach and reframes it differently.

“So, it gives you another way to visualize things and interpret it in a different way, you know? Because, you know—I mean, it’s, sort of, saying someone’s garbage is somebody else’s art form.”

Panel discussion

Participants reported being impacted differently from the exhibit itself compared to the panel discussion. Some participants stated they remembered the signs themselves the most, while others remembered what they heard during the discussions more than what they saw. One participant shared that the panel discussion, precisely the question-and-answer session of the discussion, to be the most notable because pushback from an attendee served as a reminder that not everyone feels the same way about homelessness. Another participant shared that including people who had previously experienced homelessness in the discussion was very powerful:

“I remember the discussion—the presentations by and just discussion with people who actually [had] lived in the street.. it was—it was really meaningful to hear from them.”

Sticky

And a fourth, sticky is a cross-cutting theme that describes any part of the exhibit that the participants felt “stuck” with them. This theme was identified as a cross-cutting because participants reported different aspects of the experience to have had a lasting impact on them, whether that be on an emotional, behavioral, or educational level.

Emotional resonance

“For a lot of people with signs, it’s instead of asking—so that’s the ask. But nonetheless, just in the greater context of homelessness and panhandling, the devastation of being completely invisible to people walking by, I think, really struck me.”

“I can’t see how people could walk through that exhibit and not be forever changed, even when you have the compassion for the person who holds the sign in the first place.”

Behavioral resonance

“That idea that, even if you can’t help somebody with money, you can help somebody by asking them if they’re okay, by asking them—just saying hello, by responding to their request even if it’s a “no” rather than just ignoring people.”

Educational resonance

“I remember feeling like, like it’s interesting you, a lot of these signs you’ve either, you know, seen different versions of them, or like you know you see them like out in the open, but it’s interesting when you just like take something out of an environment and hang it up and now it’s art and people are paying attention to it in a different way.”

Discussion

In the fall of 2018, artist Willie Baronet, in collaboration with a research team led by Rosemary Frasso, conducted a qualitative study exploring the lived experiences of people who panhandle in Philadelphia, described in Tate (Tate et al., 2022) and a video (Appendix C). Forty-one people were interviewed about their lives on the street, study findings were embedded into an art exhibit that included 99 signs purchased from study participants and other people who panhandle. Tate, et al. described, passersby frequently fail to acknowledge the humanity of those who panhandle, leading to a need for social connectedness (Tate et al., 2022). This follow-up study explored the impact of an art exhibit on attendees’ preconceptions of those who panhandle as a way to address this need and to examine the efficacy of art as a tool for research dissemination.

Analysis of interviews transcripts revealed four overarching themes (1) emotional resonance associated with participant’s sentiment toward those who panhandle; (2) behavioral resonance associated with their perspectives and behaviors toward those who panhandle; (3) educational resonance associated with how the exhibit served to educate participants on those who panhandle; (4) sticky, a cross-cutting theme, related to the long-lasting impact of the exhibit on attendees. The overlap between these identified themes (Supplementary Figure 1) emphasizes this approach’s causality in addressing preconceptions. The unique format of this art exhibit resonated with attendees we interviewed on an educational level, which led to emotional and behavioral resonance. Most notably, the “stickiness” of the exhibit to be remembered by participants in emotional, behavioral, and educational ways suggests the lasting impact that art can provide in as a tool to enhance the dissemination of research.

The lasting impact of the exhibit described by attendees we interviewed is consistent with findings that art as a research dissemination tool can promote social change (Yassi et al., 2016). After 18 months, attendees were able to remember specific aspects of the exhibit itself and identify changes to their attitudes and behaviors towards people who panhandle. Lankenau (1999) explained that passersby typically regard people who panhandle as a “nonperson” through acts of “othering.” As a result of this exhibit, participants reported overcoming this barrier and now view people who panhandle as humans with the ability to disrupt the natural tendency to “other” this community. Tate (Tate et al., 2022) found that those who panhandle use acknowledgment from passersby as a way to mitigate the feelings of invisibility and isolation and as a way to feel humanized (Tate et al., 2022). More often, those who panhandle experienced mistreatment, passive or active, by passersby and very seldom reported experiencing acknowledgment or support (Tate et al., 2022). The exhibit also successfully increased many attendees’ positive interactions with people who panhandle. Participants shared they now engage in interactions as simple as a smile, eye contact, or even just saying “hello.” Some interviewees also shared that they now partake in more substantial acts to engage with those who panhandle through offering money, food, clothing, or participating in deeper conversations. These findings suggest that using art to amplify research findings resonated with attendees emotionally and behaviorally with the ability to support people who panhandle.

The art exhibit was presented to attendees in a way that engaged all their senses and allowed them to interact with the signs at their leisure (Supplementary Figure 2). Certain aspects of the exhibit resonated with attendees we interviewed and appeared to be most impactful, including the use of raw materials and the presentation of the signs in the space (Supplementary Figure 3). While it may, unconsciously or consciously, be easy for passersby to ignore the signs people who panhandle hold up on the street, extracting the signs from their normal environment and artistically displaying them forced participants to pay attention to the issue. After a substantial period, these exhibit aspects still resonated with interviewee reinforcing that these techniques may be valuable in future arts-informed research projects. Art was also noted as a method of communication by interviewees, suggesting that this visual, non-traditional research approach is still a beneficial way to convey messages and educate audiences.

While prior studies focus on the use of art primarily in the humanities (Tong et al., 2007; Bower et al., 2018; Tsai et al., 2019), this paper highlights its use in public health and related disciplines. However, further investigation is needed to more thoroughly evaluate the impacts of art on learners across disciplines. Still, these findings suggest that art as a research dissemination tool can play a pivotal role in addressing the pervasive preconceptions of people who panhandle. More broadly, art allows research to have a lasting ‘sticky’ impact among participants. Taken together with previous literature (Hsieh and Shannon, 2005; Tong et al., 2007; Bower et al., 2018; Tsai et al., 2019) this study provides evidence that art serves a meaningful purpose and is a tool to consider as we disseminate research findings.

Conclusion

This study identified four overlapping themes (emotional resonance, behavioral resonance, educational resonance, and sticky) that provided evidence that art as a research dissemination tool is successful in changing preconceptions of people who panhandle with a lasting impact on participants. Art serves importance in supporting and presenting research to audiences to promote emotional, behavioral, or educational change. Further research is encouraged to explore the efficacy of art as a research dissemination tool outside the humanities discipline. These findings suggest that art may have a long-lasting resonance with those who engage with it, and therefore it may be a useful way to support research dissemination efforts. We understand that an holding an art exhibit to share study findings, may not always be practical, appropriate or feasible, we believe the use of art in other dissemination efforts is worth exploration.

Limitations

We acknowledge that there may be some selection bias in these results, as interviewees were not randomly selected from those who attended the exhibit. Furthermore, the exhibit was open to our university’s community and the public, and those who attended may have been more inclined to be moved by the work. As this study was not part of the original study design, participants were chosen from a list of those who shared their emails in the exhibit guest book or from a list of people who reached out to the PI after the event. Several recruitment emails were unanswered, and this was attributed to the fact that many of the students who attended the exhibit have graduated and likely have new addresses. In this case, there may be a bias towards more polarized opinions on the topic of panhandling, either very positive or very negative. The team was concerned about bias, thus the team identified any time bias or association to the original research team was mentioned. Some participants mentioned that they knew the senior investigator (RF), either as a colleague, professor, or former professor. They attended the exhibit either as a way to support the investigator or because they knew she was involved with the project. However, no one was obliged, or given credit for attending the exhibit. All participants stated they enjoyed the exhibit regardless of their association with the team or senior investigator and no one stated that they participated in interviews because they knew the investigator.

Data availability statement

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

Ethics statement

The studies involving human participants were reviewed and approved by Thomas Jefferson University Institutional Review Board. Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.

Author contributions

AH, AS, CD, MP, and VP: literature search. RF and WB: study design. CD, RF, and SK: data collection. AH, AS, MP, RF, and VP: transcript coding. AH, AS, CD, MP, RF, SK, and VP: data analysis. AH, AS, CD, MP, RF, and VP: data interpretation. AH, AS, MP, RF, and VP: writing. AS, CD, RF, and VP: edits and review. All authors have read and approved the publication of this manuscript.

Funding

This project was supported by the Jefferson College of Population Health and the Office of Student Life and Engagement at Thomas Jefferson University. Publication made possible in part by support from the Thomas Jefferson University Open Access Fund.

Acknowledgments

The authors would like to acknowledge all of the study participants who were willing to share their time to reflect on their experiences attending the exhibit. Additionally, we would like to thank all of the people who sold their signs to populate the exhibit.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/feduc.2022.953171/full#supplementary-material

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