Supplementary Material for: A multimethods international maPping exercise of Arts Interventions in reNal uniTs: the PAINT project

Introduction
Due to the chronic nature of kidney disease and the challenges of symptom burden, reduced mortality and co-morbidity, individuals living with the condition experience substantial anxiety and depression. Incorporating the arts into clinical practice is encouraged to promote and support mental health and wellbeing. The aim of the PAINT project was to undertake an international mapping exercise to identify the current provision of arts programmes in kidney centres for people living with kidney disease.

Methods
A multimethods approach was employed, involving a cross-sectional online survey and semi-structured qualitative interviews, which employed Qualitative Description research design. Healthcare staff working in kidney centres or organisations providing arts activities to individuals living with kidney disease were recruited into the study.

Results
One hundred and nineteen participants from 29 countries responded to the survey, with 39 of the respondents reporting arts activities in their renal unit. There was a wide range of respondents in terms of role, and the types of arts activities included visual art activities, music, literature/creative writing, film, movement/dance and craft. Individuals with chronic kidney disease who had taken part in arts activities were mostly adults (64%) and most were undergoing haemodialysis (82%). Sixteen respondents participated in the semi-structured interviews and encouraged the adoption of arts activities for people living with kidney disease. Three themes were identified: enhanced wellbeing and positive outcomes for individuals living with kidney disease; staff engagement and enthusiasm; and barriers to participation.

Conclusions
This overview of arts activities being offered globally to people living with kidney disease, and experiences of renal healthcare staff who provide activities in their units, are encouraging in terms of arts in healthcare. Thesepractitioners have observed the benefits of this person-centred arts approach in action, predominantly in terms of the positive impact on the wellbeing of individuals with kidney disease and improved relationships with staff in dialysis units. Further attention and funding should be focused on arts activities within renal centres.