Effects of A Zentangle-Textile-Art-Based Intervention On Self-Esteem and Quality of Life of Older Adults in Hong Kong


  • Chi Hin Lam The Hong Kong Polytechnic University




textile art–based intervention, older adults, Zentangle, self-esteem, quality of life


In recent years, numerous studies have explored the effects of art and craft activities on health and well-being in various social contexts. In this pilot study, the beneficial effects of a structured Zentangle-textile-art-based (ZTAB) intervention on the self-esteem and quality of life of older Hong Kong adults in community settings were investigated. The ZTAB program framework involved Zentangle drawing practice and used Borba's five-stage self-esteem model to facilitate an evidence-based evaluation. A pre-experimental and one-group pretest-posttest design was employed. Twenty-one participants completed the protocol in three steps: 1) A demographic data survey; evaluating self-esteem using the Rosenberg Self-Esteem Scale (RSES) and assessing the quality of life using the brief form of the World Health Organization's Quality of Life instrument (WHOQOL-BREF) before the intervention; 2) Participation in three ZTAB workshops; and 3) RSES and WHOQOL-BREF evaluations and a close-ended questionnaire after the intervention. The study findings revealed that the ZTAB intervention was associated with significant improvements in the participants' self-esteem and quality of life, particularly in the psychological and social relationship domains of the WHOQOL-BREF. These findings suggest that future investigations into empowering community activities that promote improved self-esteem, spiritual health, and holistic wellness among older Hong Kong adults are warranted.


American Art Therapy Association. What is art therapy. (2013). http://www.arttherapy.org/upload/whatisarttherapy.pdf

Atkins, S. S. (2002, December 15). Expressive Arts Therapy: Creative Process in Art and Life. Parkway Pub.

Betensky, M. G., & Rubin, J. A. (1995, March 1). What Do You See: Phenomenology of Therapeutic Art Expression. Jessica Kingsley.

Borba, M. (1989). Esteem Builders. A K – 8 Self- Esteem Curriculum for Improving Student Achievement, Behavior and School Climate. Torrance. CA: Jalmar Press.

Borba, M. (1994, May 1). Home Esteem Builders: Activities Designed to Strengthen the Partnership Between the Home and School. Jalmar Pr.

Brown, H. D. (2001). Teaching by principles: an interactive approach to language pedagogy (2nd ed.). Addison Wesley Longman.

Burt, E. L., & Atkinson, J. (2011, June 5). The relationship between quilting and wellbeing. Journal of Public Health, 34(1), 54–59. https://doi.org/10.1093/pubmed/fdr041

Canfield, J. (1989, October 24). How to Build High Self-Esteem?: A Practical Process for Your Personal Growth. Nightingale Conant Corporation.

Castora-Binkley, M., Noelker, L., Prohaska, T., & Satariano, W. (2010, December 20). Impact of Arts Participation on Health Outcomes for Older Adults. Journal of Aging, Humanities, and the Arts, 4(4), 352–367. https://doi.org/10.1080/19325614.2010.533396

Census and Statistics Department. (2017). Hong Kong Annual Digest of Statistics. HKSAR: Census and Statistics Department.

Chowdhary, U. (1991). CLOTHING AND SELF?ESTEEM OF THE INSTITUTIONALIZED ELDERLY FEMALE: TWO EXPERIMENTS. Educational Gerontology, 17(6), 527–541. https://doi.org/10.1080/0360127910170601

Christian U. Krägeloh, Marcus A. Henning, Susan J. Hawken, Yipin Zhao, Daniel Shepherd, & Rex Billington. (2011b). Validation of the WHOQOL-BREF quality of life questionnaire for use with medical students. Education for Health, 24(2), 545. https://pubmed.ncbi.nlm.nih.gov/22081657/

Cohen, G. D. (2006). Research on Creativity and Aging: The Positive Impact of the Arts on Health and Illness. Generations, 30(1), 7-15. https://www.questia.com/library/journal/1P3-1070989031/research-on-creativity-and-aging-the-positive-impact

Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd Edition) (2nd ed.). Routledge.

Collie, K., Bottorff, J. L., Long, B. C., & Conati, C. (2006, February 23). Distance art groups for women with breast cancer: guidelines and recommendations. Supportive Care in Cancer, 14(8), 849–858. https://doi.org/10.1007/s00520-005-0012-7

Creekmore, A. M. (1974). Clothing Related to Body Satisfaction and Perceived Peer Self. Amsterdam University Press.

Cynthia G. Scott. (1999). Modeling Self-Esteem: The Potential Impact of School Personnel on Students. Professional School Counseling, 2(5), 367. https://www.questia.com/library/journal/1P3-52068933/modeling-self-esteem-the-potential-impact-of-school

Davis, B. J. (2015). Mindful Art Therapy (Illustrated). Jessica Kingsley Publishers.

Fontelene de Oliveira, M., Moura Castro, R. C., Pereira Calou, C. G., Fontenele de Oliveira, M., de Souza Aquino, P., Lima da Silva, C. G., Barros Meireles, C., Chaves Maia, L., Linhares Miná, V. A., Nogueira Faé, B., Aguiar Santos, M. F., Vieira dos Santos, M. D. S., Batista Pereira, J., Caldas Lins, H. C., Leite Rolim Neto, M., & Bezerra Pinheiro, A. K. (2015). Ways to measuring quality of life in mental health. International Archives of Medicine. https://doi.org/10.3823/1690

de Guzman, A. B., Satuito, J. C. B., Satumba, M. A. E., Segui, D. R. A., Serquiña, F. E. C., Serrano, L. J. P., & Sevilla, M. D. (2011). Filipino Arts Among Elders in Institutionalized Care Settings. Educational Gerontology, 37(3), 248–261. https://doi.org/10.1080/03601270903534937

Denzin, N. K. (2001). Interpretive interactionism (2nd ed.). Sage Publications.

Fontichiaro, K. (2018). Making as Self-Soothing: The Power of Stitches.(LIBRARY MAKERSPACES). Teacher Librarian (Vancouver), 45(5), 53–63.

Franklin, M. (1992). Art Therapy and Self-Esteem. Art Therapy, 9(2), 78–84. https://doi.org/10.1080/07421656.1992.10758941

Futterman Collier, A. D., Wayment, H. A., & Birkett, M. (2016). Impact of Making Textile Handcrafts on Mood Enhancement and Inflammatory Immune Changes. Art Therapy, 33(4), 178–185. https://doi.org/10.1080/07421656.2016.1226647

Gail Kenning. (2015). “Fiddling with Threads”: Craft-based Textile Activities and Positive Well-being. Textile, 13(1), 50–65. https://doi.org/10.2752/175183515x14235680035304

Gandolfo, E. & Grace, M. (2010). Women doing it forever: The everyday creativity of women craftmakers. Australian and New Zealand Journal of Art Therapy. 5(1), 29–43.

Garlock, L. R. (2016). Stories in the Cloth: Art Therapy and Narrative Textiles. Art Therapy, 33(2), 58–66. https://doi.org/10.1080/07421656.2016.1164004

Greer, N., Fleuriet, K. J., & Cantu, A. G. (2012). Acrylic Rx: A program evaluation of a professionally taught painting class among older Americans. Arts &Amp; Health, 4(3), 262–273. https://doi.org/10.1080/17533015.2012.696072

Gurková, E. (2011). Hodnocení kvality života. Pro klinickou praxi a ošet?ovatelský výskum. Praha: Grada Publishing (Czech).

Hall, K., & Anderson, B. (2012). Zentangle® untangled: inspiration and prompts for meditative drawing (B. Anderson, Ed.; First edition.). North Light Books, an imprint of F+W Media, Inc.

Hess, B. B., Morris, W. W., & Bader, I. M. (1984). Hoffman’s Daily Needs and Interests of Older People, Second Edition. Contemporary Sociology, 13(6), 705. https://doi.org/10.2307/2070783

Hong, Z. R., Lin, H. S., Wang, H. H., Chen, H. T., & Yu, T. C. (2012). The effects of functional group counseling on inspiring low-achieving students’ self-worth and self-efficacy in Taiwan. International Journal of Psychology, 47(3), 179–191. https://doi.org/10.1080/00207594.2011.590494

Hsieh, M. F. and Yan, Z. X. (2010). Elderly depression. Medicine Today. 437. 169?175.

Hubalek, S. K. (1996). I Can’t Draw a Straight Line: Bringing Art into the Lives of Older Adults. Health Professions Pr.

Hui, H. M., & Ma’rof, A. M. (2019). Improving Undergraduate Students’ Positive affect through Mindful Art Therapy. International Journal of Academic Research in Progressive Education and Development, 8(4). https://doi.org/10.6007/ijarped/v8-i4/6698

Im, M. L., & Lee, J. I. (2014). Effects of art and music therapy on depression and cognitive function of the elderly. Technology and Health Care, 22(3), 453–458. https://doi.org/10.3233/thc-140803

Johnson, J. S., & Wilson, L. E. (2005). “It Says You Really Care”: Motivational Factors of Contemporary Female Handcrafters. Clothing and Textiles Research Journal, 23(2), 115–130. https://doi.org/10.1177/0887302x0502300205

Johnson, K., & Ferguson, T. (1990). Trusting Ourselves: The Sourcebook on Psychology of Women (First Edition). Atlantic Monthly Pr.

Justine Spencer, Lee-Anna Huisman, Melanie Rose van Soeren, & Kalen Leech-Porter. (2013b). A Therapeutic Waiting Room: medical students run an art group for vulnerable populations. UBC Medical Journal, 5(1). https://ojs.library.ubc.ca/index.php/ubcmj/article/view/184171

Kang, J. Y. M., Johnson, K. K., & Kim, J. (2013). Clothing functions and use of clothing to alter mood. International Journal of Fashion Design, Technology and Education, 6(1), 43–52. https://doi.org/10.1080/17543266.2012.762428

Kim, S. K. (2013). A randomized, controlled study of the effects of art therapy on older Korean-Americans’ healthy aging. The Arts in Psychotherapy, 40(1), 158–164. https://doi.org/10.1016/j.aip.2012.11.002

Krahula, B. (2012). One Zentangle A Day: A 6-Week Course in Creative Drawing for Relaxation, Inspiration, and Fun (One A Day) (unknown). Quarry Books.

LaBat, K. L., & Sokolowski, S. L. (1999). A Three-Stage Design Process Applied to an Industry-University Textile Product Design Project. Clothing and Textiles Research Journal, 17(1), 11–20. https://doi.org/10.1177/0887302x9901700102

Leone, L. (2020). Craft in Art Therapy: Diverse Approaches to the Transformative Power of Craft Materials and Methods (1st ed.). Routledge.

Liddle, J. L. ., Parkinson, L., & Sibbritt, D. W. (2013). Purpose and pleasure in late life: Conceptualising older women’s participation in art and craft activities. Journal of Aging Studies, 27(4), 330–338. https://doi.org/10.1016/j.jaging.2013.08.002

Maidment, J., & Macfarlane, S. (2011). Crafting Communities: Promoting Inclusion, Empowerment, and Learning between Older Women. Australian Social Work, 64(3), 283–298. https://doi.org/10.1080/0312407x.2010.520087

Malchiodi, C. (2014). Calm down and get your Zentangle. (2014). Psychology Today. http://www.psychologytoday.com/ blog/arts-and-health/201403

Masika, G. M., Yu, D. S. F., & Li, P. W. C. (2020). Can Visual Art Therapy Be Implemented With Illiterate Older Adults With Mild Cognitive Impairment? A Pilot Mixed-Method Randomized Controlled Trial. Journal of Geriatric Psychiatry and Neurology, 34(1), 76–86. https://doi.org/10.1177/0891988720901789

Miller, V. (2010). Zentangle Art as a Spiritual Practice. (2010). My Chair. http://verlin frommychair.blogspot.com/2010/07/zentangle-as-spiritualpractice.html

Minahan, S., & Cox, J. W. (2007). Stitch’nBitch. Journal of Material Culture, 12(1), 5–21. https://doi.org/10.1177/1359183507074559

Myers, J. E., Willse, J. T., & Villalba, J. A. (2011). Promoting Self-Esteem in Adolescents: The Influence of Wellness Factors. Journal of Counseling &Amp; Development, 89(1), 28–36. https://doi.org/10.1002/j.1556-6678.2011.tb00058.x

Netuveli, G. (2006). Quality of life at older ages: evidence from the English longitudinal study of aging (wave 1). Journal of Epidemiology &Amp; Community Health, 60(4), 357–363. https://doi.org/10.1136/jech.2005.040071

Noice, H., Noice, T., & Staines, G. (2004). A Short-Term Intervention to Enhance Cognitive and Affective Functioning in Older Adults. Journal of Aging and Health, 16(4), 562–585. https://doi.org/10.1177/0898264304265819

Nolen-Hoeksema, S. (2001). Gender Differences in Depression. Current Directions in Psychological Science, 10(5), 173–176. https://doi.org/10.1111/1467-8721.00142

Orth, U., Robins, R. W., Widaman, K. F., & Conger, R. D. (2014). Is low self-esteem a risk factor for depression? Findings from a longitudinal study of Mexican-origin youth. Developmental Psychology, 50(2), 622–633. https://doi.org/10.1037/a0033817

Pollanen, S. (2015). Elements of Crafts that Enhance Well-Being: Textile Craft Makers’ Descriptions of Their Leisure Activity. Journal of Leisure Research, 47(1), 58–78. https://doi.org/10.1080/00222216.2015.11950351

Reitzes, D. C., Mutran, E. J., & Verrill, L. A. (1995). Activities and Self-Esteem. Research on Aging, 17(3), 260–277. https://doi.org/10.1177/0164027595173002

Rentz, C. A. (2002). Memories in the Making©: Outcome-based evaluation of an art program for individuals with dementing illnesses. American Journal of Alzheimer’s Disease &Amp; Other Dementiasr, 17(3), 175–181. https://doi.org/10.1177/153331750201700310

Rev. Mary Louise Meadow, Eva Beyerl. (1999). Becoming Whole: A Pastoral Story. Health Care for Women International, 20(4), 427–432. https://doi.org/10.1080/073993399245700

Reynolds, F. (2000). Managing depression through needlecraft creative activities: A qualitative study. The Arts in Psychotherapy, 27(2), 107–114. https://doi.org/10.1016/s0197-4556(99)00033-7

Reynolds, F. (2010). ‘Colour and communion’: Exploring the influences of visual art-making as a leisure activity on older women’s subjective well-being. Journal of Aging Studies, 24(2), 135–143. https://doi.org/10.1016/j.jaging.2008.10.004

Riley, J., Corkhill, B., & Morris, C. (2013). The Benefits of Knitting for Personal and Social Wellbeing in Adulthood: Findings from an International Survey. British Journal of Occupational Therapy, 76(2), 50–57. https://doi.org/10.4276/030802213x13603244419077

Rosenberg, M. & Princeton University Press. (1965). Society and the Adolescent Self-image. Amsterdam University Press.

Roberts, R., & Thomas, M. (2022). The Book of Zentangle. Zentangle Books & Creations.

Roswiyani, R., Kwakkenbos, L., Spijker, J., & Witteman, C. L. (2017). The Effectiveness of Combining Visual Art Activities and Physical Exercise for Older Adults on Well-Being or Quality of Life and Mood: A Scoping Review. Journal of Applied Gerontology, 38(12), 1784–1804. https://doi.org/10.1177/0733464817743332

Schieman, S., & Campbell, J. E. (2001). Age Variations in Personal Agency and Self-Esteem. Journal of Aging and Health, 13(2), 155–185. https://doi.org/10.1177/089826430101300201

Schofield-Tomschin, S., & Littrell, M. A. (2001). Textile Handcraft Guild Participation: A Conduit to Successful Aging. Clothing and Textiles Research Journal, 19(2), 41–51. https://doi.org/10.1177/0887302x0101900201

ShahbazzadeghanB., Rabiollah Farmanbar, Ghanbari Atefeh, Z Atrkar Roushan, & Masoomeh Adib. (2009). The Effect of Regular Exercise on Self-esteem in Elderly Residents in Nursing Homes. Journal of Ardabil University of Medical Sciences, 8(430), 387–393. http://jarums.arums.ac.ir/files/site1/user_files_902ca9/sadeghian-A-10-27-268-5f60877.pdf

Skevington, S., Lotfy, M., & O’Connell, K. (2004). The World Health Organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A Report from the WHOQOL Group. Quality of Life Research, 13(2), 299–310. https://doi.org/10.1023/b:qure.0000018486.91360.00

Snir, S., & Regev, D. (2013). ABI – Art-based Intervention Questionnaire. The Arts in Psychotherapy, 40(3), 338–346. https://doi.org/10.1016/j.aip.2013.06.005

Sofia von Humboldt, & Isabel Leal. (2012, December 1). Person-Centered Therapy and Older Adults’ Self-Esteem: A Pilot Study with Follow-up. Studies in Sociology of Science, 3(4), 1–10. https://doi.org/10.3968/j.sss.1923018420120304.753

Stavropoulos, V., Lazaratou, H., Marini, E., & Dikeos, D. (2015). Low Family Satisfaction and Depression in Adolescence: The Role of Self-Esteem. Journal of Educational and Developmental Psychology, 5(2). https://doi.org/10.5539/jedp.v5n2p109

Stevenson, M., & Orr, K. (2013). Art therapy: stimulating non-verbal communication. Nursing and Residential Care, 15(6), 443–445. https://doi.org/10.12968/nrec.2013.15.6.443

Tate, B. (2014, February 28). Zentangle offers opportunity to find inner peace via art. The Brunswick News. https://thebrunswicknews.com/life/zentangle-offers-opportunity to-find-inner-peace-via art/article_d030a5c0-ed09-53fe-b71d-e26ff30f8b5b.html

Tse, M. M.., & Ho, S. S.. (2010). Management of chronic pain for older persons: a multisensory stimulation approach. Journal of Cyber Therapy and Rehabilitation, 3(3), 313–323.

Turney, J. (2004). Here’s One I Made Earlier: Making and Living with Home Craft in Contemporary Britain. Journal of Design History, 17(3), 267–282. https://doi.org/10.1093/jdh/17.3.267

Uttley, L., Scope, A., Stevenson, M., Rawdin, A., Taylor Buck, E., Sutton, A., Stevens, J., Kaltenthaler, E., Dent-Brown, K., & Wood, C. (2015). Systematic review and economic modelling of the clinical effectiveness and cost-effectiveness of art therapy among people with non-psychotic mental health disorders. Health Technology Assessment, 19(18), 1–120. https://doi.org/10.3310/hta19180

Utsch, H., & Ellenhorn, T. J. (2007). Knitting and stress reduction. Thesis (Psy.D.) --Antioch New England Graduate School, 2007.

WHOQOL GROUP. (1998, May). Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychological Medicine, 28(3), 551–558. https://doi.org/10.1017/s0033291798006667

Willem Kuyken, John Orley, Mick Power, Helen Herrman, Hilary Schofield, B. Murphy, Željko Metelko, Silvija Szabo, Mirjana Pibernik-Okanovi?, N. Quemada, A. Caria, S. Rajkumar, S. Kumar, Shekhar Saxena, Dan Bar-On, M. Amir, M. Tazaki, A. Noji, G. Vanheck, . . . G. Burkovsky. (1995). The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization. Social Science &Amp; Medicine, 41(10), 1403–1409. https://doi.org/10.1016/0277-9536(95)00112-k

WOODHILL, B. M., & SAMUELS, C. A. (2003). Positive and negative androgyny and their relationship with psychological health and well-being. Sex Roles, 48(11-12), 555–565. https://doi.org/10.1023/A:1023531530272

Zaninotto, P., Falaschetti, E., & Sacker, A. (2009, October 6). Age trajectories of quality of life among older adults: results from the English Longitudinal Study of Ageing. Quality of Life Research, 18(10), 1301–1309. https://doi.org/10.1007/s11136-009-9543-6