We also identify and classify the analogical principles reported in the field data. Based on this classification, we address the phenomenological dimension of the ethnobiological repertoires and discuss the epistemological and ontological foundations of this form of reasoning. We also hypothesize on the role of analogism shaping ethnobiological repertories more generally in Brazil.The heuristic model we apply—articulating phenomenology, epistemology and ontology—could prove valuable in ethnobiology and the emerging field of “anthropology beyond the human.” The ethnobiological repertoires we analyze comprise food taboos, pregnancy and post-partum restrictions, medical practices, interventions aimed at improving humans’ and dogs hunting skills, and other interactions with non-human entities. These practices are referred to by local people at both fieldwork sites as simpatias (“sympathies”), and outsider-anthropologists might describe them as “sympathetic magic.” We avoid the term “magic” in our discussion, however, paying heed to Arthur C. Clarke’s [This article discusses the analogical reasoning shaping uses and practices involving fauna and flora among traditional Clarke’s  admonitiIn this article, we analyze analogism in these ethnobiological repertoires taking into account phenomenological, epistemological, ontological and historical components. The phenomenological dimension of our analysis consists in accessing sensory inputs impacting individuals’ ethnobiological repertories about nature and its uses –4. We apAs a philosophical tradition, phenomenology breaks from the Cartesian intellectualist paradigm and reintroduces the experience of the concrete world as a starting point for understanding human knowledge. To phenomenologists, perception is conceived as an immediate, sensory, and non-reflective instance of human experience, which precedes and sustains any rational  expression of knowledge , 22. EpiFollowing Ingold , we focuWe approach epistemology in our analysis proposing a critique and an update to the predominance of folk taxonomy in classic ethnobiological studies , 27–33, Among the prominent authors associated with the “ontological turn” in anthropology, Philippe Descola , p. 121 In naturalism, which according to Descola is restricted to modern Western thinking, all entities in the world are unified by physicality  but distinguished by interiority, with only humans expressing subjective intentionality. In animism, all entities are linked by the same interiority , but are dissimilar in terms of exteriority . This ontological regime has been described by Eduardo Viveiros de Castro  as “persAccording to Descola , in an aIn addressing analogism as observed among the study communities, we do not exclude the possibility of other ontological regimes in operation in the two ethnographic contexts. As proposed by Descola, the four ontological models are not mutually exclusive, and are sometimes found side by side in the same society. Moreover, Sahlins  has arguIn his comparative analysis, Philippe Descola identifies analogism among societies in China, Africa, and pre-Colombian Mesoamerica, as well as in medieval and Renaissance Europe. This geographical association enters into our historical analysis as we raise the following question: could analogism have become pervasive in non-indigenous ethnobiological repertories in Brazil via Portuguese colonization? We evaluate this question in the Discussion, hoping to stimulate new research into the epistemic regularities observed in these Brazilian ethnobiological repertories, and their possible historical and geographical origins. Finally, we outline how ethnobiologists might use this analytical framework to better evaluate the multiple layers of knowledge and practice found in ethnobiological repertories, including phenomenological, epistemological, ontological and historical dimensions.The Ribeira valley is located in southeast Brazil, between the states of São Paulo and Paraná, occupying an area of 2,830,666 ha  Fig. 1)1). The cquilombola communities of the middle Ribeira valley were founded by escaped, freed or abandoned slaves during the colonial period in Brazil, from the late eighteenth century to the early nineteenth century [coivara) supplemented by animal husbandry has been the main mode of food production of these populations since their origins, also representing an important element of cultural identity among them [The  century . Slash-aong them –72.Over the past half century, important socio-cultural changes have marked the quilombola population in the region. Disputes over land, economic pressure, and the imposition of environmental legislation, in addition to overlap with protected areas, have discouraged some traditional practices, especially “slash and burn” swidden cultivation . GreaterIn terms of domestic economy, the population is currently composed mostly of family farmers who also practice small-scale extractivism and subsistence hunting . Other sterra firme forest predominates, with smaller areas of white-sand savanna (campinarana) and seasonally flooded várzea (white water) and igapó (black water) forests [Created in 1998 and located between the Negro and Japurá river basins, the Amanã Sustainable Development Reserve (ASDR), totaling 2,350,000 ha, is one of the largest protected tropical forest areas in South America. Upland  forests . The cli forests .Amanã lake is 45 km long and 2–3 km wide Fig.  and harbcaboclos, as well as migrants from northeast Brazil, referred to in the region as arigós [caboclo society reaches back to the early Portuguese colonization of the Amazon, including a strong indigenous component in its constitution [arigós, on the other hand, came to the region as part of migrations from northeast of Brazil during the Rubber Boom in Amazonia [arigós in Amanã would have initially migrated to the upper Juruá  and independent (or isolated) households [s arigós . The fortitution –83. The Amazonia . The fircaboclo [ribeirinho (“river-dweller”) to refer to the population of ASDR. Historically, folk Catholicism in combination with indigenous cosmologies form the main religious matrix in Amanã. Catholic priests of the “liberation theology” movement were important figures in the political organization of these communities beginning in the 1960s [Several authors have pointed out the analytical limitations and racism inherent in the concept of caboclo , 86, so he 1960s . In a reribeirinhos residing in ASDR subsist on a mixed economy based on agriculture, fishing, hunting and extractivism, and may benefit from federal poverty relief programs [Today, the programs . ResearcThe analogies reported in this study were recorded during semi-structured interviews and informal conversations during ethnographic research on hunting practices, pregnancy and post-partum food taboos, and other aspects of ethnoecological knowledge. The semi-structured interview protocol included the following guiding topics : (1) lifLocal terms appear in the text and tables in italics, accompanied by an English gloss where one exists. Taxonomic nomenclature  is mentioned only upon first appearance. We identified plants using botanical identification guides of native and exotic species in Brazil –92. We iIn the Ribeira, observations were recorded during five expeditions for a total of 45 fieldwork days between December, 2018 and January, 2020, comprising 24 participants: sixteen women and eight men between 35 and 82 years of age. Observations at Amanã resulted from two visits and a total of 30 fieldwork days between January and March, 2019, with 24 participants: fifteen women and nine men between 24 and 79 years of age. Despite the difference in fieldwork effort, we made sure to include a similar number of respondents and a similar gender ratio between the two study regions. Observations were recorded by the same interviewers in both study areas (HMP and TLS).Participants were selected based on an adaptation of the “snowball” technique , whereby“The huntress wasp, she catches spiders and takes them to her burrow... So you kill the wasp and roast it and give it to the dog to eat... Then the dog will be good at hunting burrowing animals... armadillo, peccary, things that hide in holes like that.” .caçadeira (‘huntress’). When asked what was special about this insect for it be used in this way, Zeca provided the explanation cited above. For Zeca, feeding the dog powder made from the ‘huntress’ wasp makes it better able to hunt burrowing animals, such as tatu , cutia  and paca (Cuniculus paca).In the initial days of fieldwork in the Ribeira valley , author HMP was talking with Zeca  about using dogs to locate and capture game animals. At one point, Zeca mentioned a tried and true remedy for making dogs into fierce hunters: feeding the dog a powder made by roasting and grinding a certain wasp species, which he referred to as embaúba tree (Cecropia sp.), drying it over a fire or in the sun and then burning it and blowing the smoke over the dog. This treatment improves the dog’s ability to corner animals that, like the Cecropia leaf, “live up high,” namely arboreal animals such as quati , primates, and highly sought-after bird species such as jacu  and jacutinga .Later, Zeca described another treatment for hunting dogs that involved taking a leaf of the caçadeira wasp was likened to the burrowing habit of certain game animals, while the height from which the Cecropia leaf falls was likened to the arboreal habits of certain other game species.At this point, researcher HMP became interested in the logical principles structuring these and other uses of animals and plants among this population. The same relational principle appeared to underlie these two use reports: the burrow of the emanators and receivers. Both treatments described by Zeca reveal relationships forged perceptually and intellectually by a general principle of “sympathetic” or analogical reasoning.These and other uses and practices revealed different inhabitants’ intellectual effort to identify behavioral or ecological similarities between organisms as biologically distinctive as wasps and dogs, or trees and arboreal animals. Such correspondences, in turn, provide a mechanism for the transmission and acquisition of certain desirable qualities between entities that we refer to as Based on this revelatory incident, we began to explore the principles guiding a wide range of plant and animal uses, adapting our initial ethnographic study (focused on livelihood strategies) to include systematic reports of such analogical practices in the two study regions. In the ensuing work, we recorded 60 different examples of analogical rationality related to different plant and animal uses and practices observed in current daily activities Table .Table 1AAmong the diversity of treatments, restrictions and other practices encountered, those involving pregnancy, childbirth and the post-partum period (grouped together under the category of “Childbearing”) accounted for 24 (40%) of the 60 analogical uses recorded  that unifies two otherwise entities, and on this basis, an intervention is performed that establishes a causal relationship (transmission) between the parts, through which a quality is transmitted from one entity (emanator) to another (receiver).The five components defined above are linked as follows: sympathy or activating features: animal behavior , physical state , morphology , part-whole relationships , function , preparation mode , and color, development stage, shape and lifestyle that were observed in one case each. The latter refers to specific requirements in preparing or administering a treatment to achieve the desired outcome, for example the importance of placing huntress wasp powder in a single spot in the dog’s food, rather than spreading it  correspond to 75% of the recorded analogies. There are two cases that do not seem to involve a process of transmission of properties between the entities but, rather, more of an iconic signaling. These include the poetic metaphor of the “pouring moon” (No. 54), which signals rain, and the behavior of the laughing falcon (No. 52), which can indicate rain or drought depending on whether it lands on a leafy or dry tree.e.g., duck and chicken). Ten analogies (16.6%) contained plants or humans as emanators of properties, and three analogies were categorized as “Other” (5%) such as the “pouring moon” (No. 54) and clothing color (No. 47). In 33 analogies (55%), humans are the direct receivers, acting as indirect receivers in the remaining 27 analogies (45%).A wide variety of emanator entities, especially animals, were recorded. These were present in 47 analogies  and include terrestrial and aquatic mammals, bats, reptiles, birds, fish, insects and domestic animals ; the administration of the reproductive organ of the coati as a sexual stimulant (No. 50); or the avoidance of eating watermelon due to its copious red juice by women during menstruation (No. 59).The In some cases, the emanator has some feature related to a third target entity. For example, bats and ants (emanators) that live in groups are administered to a dog (receiver) to improve its ability to corner herd animals (peccaries). In this case, the character of interest can be understood as a way of making the dog attentive to a specific kind of prey. A more direct example of this modality is the practice of blowing the smoke of burnt puma or jaguar fur on a dog to make it a good tracker of large felines (No. 15).Ribeirinhos of the Amanã context also perform empirical experiments aimed at determining the suitability of a given specimen for use. For example, hunters in Amanã would butcher a prey animal and wait for insects to arrive to feed on it. The first individual to land on the carcass “has a good sense of smell” and is therefore captured for administration to dogs .Attributes associated with animal behavior were the most commonly noted in our records. The slow movement of the tortoise and its ability to retract its head are examples of behavioral attributes that were referenced in certain practices . activating attribute related is not restricted to its natural condition, but may also involve the situation in which it was killed or butchered for consumption. Two examples from Ribeira involved prohibitions about consuming animals captured using a certain kind of trap known as mundéu. In this trapping technique, small to medium-sized animals such as armadillo, agouti or paca are attracted to a fenced wooden structure, triggering the fall of a heavy tree trunk that crushes the animal. In the analogies reported, the injury the trap causes to the animal can appear in a person who eats its meat (No. 39) or in an infant whose mother has eaten its meat (No. 38).An animal’s couvade, such that the diet and behavior of father and mother alike can influence the well-being of a gestating and recently born child [Such behavioral activating features also include human behavior toward animals. Five analogies reported in Amanã involve the mistreatment of hunted animals, such that a newborn child suffers as the animal suffered, resembles the abused animal, or is born with the same physical disfigurement to which the animal was subjected (Nos. 28–32). In another case, physical effort exerted by the father causes a child to suffer during gestation (No. 33). This example is part of a widely held set of beliefs, practices and restrictions among Amazonian populations surrounding rn child .The concept of “activators” that we develop here fits in with the broader effort within ethnobiology to understand the function as well as origin of use repertoires. In the field of ethnobotany in particular, the ecological apparency hypothesis  has beenShepard  proposesquilombola and ribeirinho “sympathies” go beyond the merely sensorial to encompass more complex aspects of animal behavior and forest ecology. Coupled with analogical reasoning, this attention to habit and behavior, especially in the use of fauna-based remedies, describes a systematic theory of “ethological” apparency in these, and certainly other, ethnozoological repertoires. As is the case with the “Doctrine of Signatures” in ethnobotany [While perceptual cues, especially visual  are certainly important in the analogical theories described here, salient traits such as intelligence, ferocity, foraging habit and sociality that are identified and activated by nobotany , such ranobotany –110. In japiim (yellow-rumped cacique), various primate species and the tucuxi dolphin, are all considered to be “very intelligent” animals , justifying their use to improve the acuity of hunting dogs in Amanã.The analogical rationality reported here can be understood as an intellectual process that extends from the phenomenology of environmental perception, establishing and elaborating relationships between the entities. In this way, chains or series of otherwise unrelated entities become causally associated by means of the activating feature. In the cited uses, for example, a group of unrelated animals, the caititu (peccaries), which also live and forage in herds (Nos. 9 and 10). A third example, also from Amanã, involves animals recognized as good predators, such as calangos (lizards), vespas (wasps) and “hunter beetles” . These are likewise administered to dogs to improve their hunting abilities.Likewise, bats and army ants both demonstrate social behavior leading to their agglomeration in large groups for roosting and foraging, respectively. Treatments prepared from both types of animal are administered to hunting dogs in Amanã to improve the ability of dogs to track In the cases exemplified above, organisms as distinctive as birds and aquatic mammals, peccaries and bats, or lizards and wasps are grouped according to perceptually salient, though not taxonomically significant, shared behaviors. These latent, decidedly non-natural groupings appear to contradict prominent theories regarding the culturally universal features of folk biological classification systems , 32, 33,With regard to cognitive aspects of such classification processes , the degMainstream Western approaches to scientific as well as folk biological taxonomy infer diachronic continuity from a given set of similarities deemed salient for classificatory purposes. This epistemic process, which emerges from a “naturalistic” ontology, is evident for example in concepts like genealogy and evolutionary history in the natural sciences, as well as for arguments about the importance of morphological similarities produced by evolution in studies of folk biology. By contrast, the analogical knowledge practices reported here work in somewhat the opposite fashion, such that similarities are inferred from salient, synchronic continuities Table . This kiquilombola and ribeirinho communities in Brazil  where distance does not prevent transmission , the useribeirinho and quilombola cases presented here, indigenous Amazonian use rationales that follow an apparently analogical or homeopathic pattern of “like treats like” reveal a decidedly animistic logic of sympathetic transmission mediated by spiritual “owners” or “masters” [We were particularly struck by the tremendous similarities in the analogical rationality at work in these geographically distant, ecologically distinctive and demographically unrelated populations, including certain nearly identical use patterns, for example, the administration of wasp preparations to hunting dogs. It is of course possible that certain general concepts or specific ethnobiological practices were absorbed through syncretism with indigenous populations that occupied these regions prior to colonization. However, the geographical distance would preclude a common origin of any specific cultural knowledge. Moreover, and in contrast to the masters” , 4.It is also possible that similar concepts and practices might emerge independently, despite the ecological and geographical distance. However, we suggest that the observed similarities in these ethnobiological repertoires reflects the pervasive historical presence of colonial Portuguese cultural influences in the genesis of these otherwise distinctive social formations. Analogical or “sympathetic” reasoning, which originated in ancient Greece, was dominant throughout Europe until at least the eighteenth century, and was especially prevalent on the Iberian Peninsula, where Greek influences were expressed doubly through European as well as Arabic sources, notably in the context of religious and medical practices , 113.reima in the Brazilian Amazon, is clearly a reflection of Hippocratic-Galenic humoral theory [The widely documented classification of “hot” vs. “cold” foods, illnesses and remedies in Brazilian folklore, as well as the concept of l theory –117 as tl theory , 119. Thl theory . While hl theory , 115, “hl theory , probablquilombolas in southeast Brazil and ribeirinhos in Amazonia is primarily a legacy of Portuguese colonization, we would expect to find an “analogical” signature in the ethnobiological repertoires of rural populations throughout Brazil. A cursory review of ethnobiological studies among rural Brazilian communities, especially zootherapeutic practices, indeed reveal a suggestive prevalence of analogical uses [If we assume that analogism among cal uses –110, 120cal uses , 122.quilombola communities of the Atlantic forest and ribeirinhos of the Brazilian Amazon. Going beyond a mere listing of species and their uses, we have explored the phenomenological, epistemic, and ontological components that shape peoples’ environmental experiences and interactions. The analogistic practices we report seem to manipulate the flow of qualities among different things and beings in the world by recognizing that certain salient features of these entities are external signs of potentially transmissible qualities. We understand the simpatias used by quilombolas and ribeirinhos alike as a way of exerting control over important phenomena, beings and things in their environment, a systematic technology, as opposed to a haphazard collection of superstitions, that is fine-tuned to their ecological surroundings and ontological assumptions.In this article, we have analyzed the analogical rationalities that govern ethnobiological use repertories among We propose that the origin of analogical reasoning in these two geographically distant rural communities is due in part to the history of Portuguese colonization. In this way, we link the historical dimension of the study to its phenomenological, epistemological, and ontological components. We believe that our study provides a model for expanding the scope of ethnobiological research among rural populations of Brazil, which to date has been largely concerned with species diversity and knowledge preservation on a case-by-case basis, with little attention to epistemic and ontological dimensions, historical processes or comparative methods.The analytical method we develop here might contribute more broadly to emerging approaches in multispecies ethnography  and “ant


Socially assistive robots are being designed to support people’s well-being in contexts such as art therapy where human therapists are scarce, by making art together with people in an appropriate way. A challenge is that various complex and idiosyncratic concepts relating to art, like emotions and creativity, are not yet well understood. Guided by the principles of speculative design, the current article describes the use of a collaborative prototyping approach involving artists and engineers to explore this design space, especially in regard to general and personalized art-making strategies. This led to identifying a goal: to generate representational or abstract art that connects emotionally with people’s art and shows creativity. For this, an approach involving personalized “visual metaphors” was proposed, which balances the degree to which a robot’s art is influenced by interacting persons. The results of a small user study via a survey provided further insight into people’s perceptions: the general design was perceived as intended and appealed; as well, personalization via representational symbols appeared to lead to easier and clearer communication of emotions than via abstract symbols. In closing, the article describes a simplified demo, and discusses future challenges. Thus, the contribution of the current work lies in suggesting how a robot can seek to interact with people in an emotional and creative way through personalized art; thereby, the aim is to stimulate ideation in this promising area and facilitate acceptance of such robots in everyday human environments. The current article proposes that social robots will follow the path of smartphones in becoming prevalent, once they too appear to provide various forms of value at reasonably low cost (hereafter referred to as the “smart phone hypothesis”). This will involve helping not just with everyday tasks and emergencies, but also with fulfilling our social needs, to help us to flourish . In parTo get started in this complex and challenging scenario, a basic outline of the design space was required: A primary concern was to identify norms and underlying “codes” that could provide value for various users–but personalization was also deemed to be important, as somaesthetic experiences like art-making are highly idiosyncratic . FurtherTo address the goal, a speculative prototyping approach was adopted, combining the insights of both engineers and artists, to derive a theoretical design and practical implementation, which could be checked and refined via a small user study: Speculative design facilitates the formation of concrete ideas and problem detection in expansive, ambiguous design spaces . An explThe remainder of this article is organized as follows: The idea of robots that can make art has long fascinated , and intMany art-making robots have been created by artists and engineers, for various audiences to see or interact with; here only a few examples can be described. Robot morphologies are diverse, comprising robot arms, as well as humanoid, vehicular, flying, and even animal-like robots . One coA typical example of an exogenous system could be a photocopier, printer, or plotter, which require and are directly controlled by a person’s input. More uncommonly, prototypes can be controlled via facial images, eye movements, body movements, or sound: For example, a person can get their portrait done by showing their face to a humanoid robot  or arm rIn contrast, an extreme example of an endogenous system that does not react to people could be a robot arm that is programmed to paint one specific scene, and nothing else. More complex systems can use aleatoric uncertainty to generate interesting art : For exaThe idiosyncratic nature in which art is perceived also suggests the importance of personalization. Some related knowledge has been elucidated in the field of empirical aesthetics in regard to beauty evaluations . For exPersonalization is conducted by applying knowledge of users to a system’s behavior, and can be seen inter alia on the web in recommendations, advertisements, search results, and social media content; in interactive learning systems, through question selection based on “knowledge tracing”; in product development in the form of data-driven “personas”; and in commercial products such as mugs, shirts, books, and statues that use photos, names, or 3D data. Typically, personalization in the digital realm involves user models and profiles: a model describes how a user can be represented in terms of some properties of interest like name or gender, which is used to structure a user profile, the data for a specific user or group. Data can be obtained explicitly in a “user-driven” manner by directly querying users, or implicitly in a “system-driven” manner, where either approach has benefits and demerits; explicit user-driven approaches can overwhelm users, who also might not know exactly what they want from the start, whereas system-driven approaches can incorporate restrictive hidden biases.Some concerns in defining a user model include what properties to consider and how to structure them, as well as how the data will be obtained and used. Many possible properties could affect the perception of emotions in visual art, with commensurately many possible model configurations. A naïve or brute force method might seek to obtain data for every single concept that could be expressed through art from a person, which is not likely to be practical. At a higher level of abstraction, stereotypes can be used; for example, properties felt to be important for the emotional rating of art that were included in the OASIS affective image dataset include age, gender, geographic location, race, ideological self-placement, and socioeconomic background  . For comThus, the literature did not clarify how to design a socially assistive painting robot, which uses a personalized model to visually convey emotions; it seems like few studies have investigated the degree of overlap in people’s perceptions of emotions in art, or how this can be modeled  and how this can be transparently integrated into a system that can move from theoretical concepts to a concrete painting.The current section summarizes some of our previous work, which involved first identifying a basic scenario informed by the related literature . For simBased on this scenario, our group of artists and engineers followed a mid-fidelity research prototyping approach to gain some insight . Thus, tOne idea that emerged from the sessions was that an exogenous robot could paint in a contingent way to indicate empathy. Contingent in Human-Robot Interaction (HRI) means “related” or “connected,” such that there appears to be “a correspondence of one’s behaviour to another’s behaviour” . The simAnother enjoyable interaction involved an artist painting together with the robot on a shared canvas, where the robot painted endogenously, independently of the artist. This felt creative and artistically interesting, since the artist could improvise, draw ideas, and build on what the robot painted. However, the lack of awareness from the robot of the human’s behavior, and thereby the lack of a connection or bond, also felt like a human working with a machine, not a partner. Thus, both strategies felt limiting due to their one-way nature.This led us to consider if a robot could produce art that balances exogenous and endogenous components to appear both empathetic and creative; thus, a robot could base its art partially on what a human does, and partially on its own intentions . In general, such a need exists, for robots to interact effectively in relation to social and emotional aspects, to improve their competence and support positive user experiences . For exaAs a first step to explore such a strategy, the use of a “visual metaphor” was proposed: namely, that a robot can paint something that is similar in emotional meaning but different in creative expression. This is loosely in line with the concept of the “adjacent possible”  that desThis concept thus has both an emotional and a creative side, and art in general can be seen as comprising both sides, as discussed in “Expression Theory” . From th• (a) Canvas sharing. To avoid interrupting a person while they paint, a robot can either predict a person’s intentions and motions and plan accordingly, or more simply, follow a turn-based interaction design. In the latter case, a person could indicate that it is the robot’s turn to paint haptically, verbally, or visually–each with some potential demerits. For example, it might be difficult for a person with a cognitive disorder to haptically control a robot, which is not required in typical interactions with humans. Controlling a robot verbally using CMU PocketSphinx  or Googl• (b) Art and Biosignal Analysis. To seem contingent, the robot should perceive what the human has expressed. Given that paintings are primarily visual, a camera, either on the robot or in the room, can be used to analyze a person’s painting. Algorithms will likely become increasingly capable of high-level summarization and observation; currently, low-level and mid-level analysis is typical, which involves detecting colors, lines/shapes, composition, and depicted objects. One complementary alternative is to also detect biosignals linked to emotion, such as heart or respiratory rate, skin conductance, muscle current or brain activity; we used the latter in our previous work, which required the user to wear a Brain-Machine Interface. For our current prototype, a camera on the robot was used. Conversion in OpenCV to HSV  space was conducted to color-pick six basic hues and calculate their average intensity, while using the Hough Transform to detect lines.• (c) Emotion Inference. Next, the robot should seek to infer the emotional meaning underlying the physiological signals detected, such as visual expression or brainwaves. A generic model based on some emotion model could be used, or a personalized profile with information on how a person associates art with emotions, if available. How such a profile could be constructed based on querying a user is considered in the next section.How then to incorporate this concept into a semi-autonomous interaction? As shown in • (d) Metaphor Selection. The next step involved finding a new way to express a detected emotional meaning. Nouns with a similar emotion connotation could be looked up via a large sentiment lexicon such as Affective Norms for English Words (ANEW) , SentiWoFor our initial prototype, some simplified heuristics related to the visual arts were used in conjunction with a generic dimensional model of emotion: A linear combination of features based on detected colors and lines was used to calculate valence and arousal, for which Ståhl’s model was used to calculate a contribution of each hue by area: this model provides a way to link colors to emotions, by rearranging Itten’s color circle to fit Russell’s Circumplex Model of Affect . Intensi• (e) Image Generation (Reification). A plan is required to move from a metaphor like “dog” to a specific image of a dog to paint. For example, a generative approach, in conjunction with examples of dog images from Google Image Search or ImageNet , could bFor our prototype, a simplified capability was implemented to search two affective image databases, namely the Open Affective Standardized Image Set  Painting Plan and Execution. Next, the robot should move to paint the target image on the canvas. This part of the process, although also challenging, has seen much focus in previous work, e.g., using visual control loops  It is a.) An advFor initial exploration, Deep Convolutional Generative Adversarial Networks (DC-GANs) were used to develop compositions. Some challenges related to time were encountered, that prohibited the kind of online interaction we wished to achieve: web-scraping many images required much time; even with small MNIST-sized  grayscalAbove, steps (C)-(E) allow for personalization. As a useful starting point for exploration, the current article proposes a Folksonomic-style model, in which open questions are used to capture symbols that exert a large emotional effect on an individual. A Folksonomy is a taxonomy formed by allowing users to add their own idiosyncratic tags to describe content ; such a This overall process for art-making can be repeated over multiple turns, thereby closing the “affective loop”: perceiving emotions, acting, checking the result, and refining. A video describing this initial prototype is available online .In developing an initial prototype, the current article posited that people would rather interact with a robot that balances exogenous and endogenous content to appear both contingent and creative, rather than just one or the other, but arguments can also be made to the contrary: Since robot art systems today are often controlled by humans (exogenous) or paint independently without humans (endogenous), people might prefer a system that is not creative but is just controlled by them due to familiarity with using tools, as familiarity supports usability and technological acceptance, and control supports enjoyment; or conversely, people might prefer a system that is not contingent but generates good art regardless of human performance, and can surprise, kindle imagination, stimulate, and inspire. Moreover, questions existed about how people would perceive personalized art in various forms, such as abstract or representational.• System 1: Exogenous (dependent on the person’s art)• System 2: Endogenous (independent of the person’s art)• System 3: Proposed To provide exploratory insight into these questions, a user study was conducted. As noted previously, the core approach in this article is speculative design, where often there is no user study (or even implementation); the user study here merely aimed to explore the above concepts from another perspective. For this, a simplified scenario was adopted in regard to robot strategies, the degree of personalization, the kind of art, and target emotions: For the robot’s art strategy, three systems were considered:Personalization was examined in a binary manner, as either generic or personalized, where the generic art was taken into account as a starting point when developing the personalized art. Likewise, the form of art was examined in a binary manner, as either abstract or representational. Since the aim was to obtain insight into how visual expressions can be personalized and the focus was not on the implementation, paintings were represented using sketches which require less time to produce, following the spirit of our prototyping approach. For target emotions, four representative discrete emotions were selected, one per quadrant in valence-arousal space, in line with Russell’s circumplex model : happy , relaxed , sad , angry  . Three ; a relaxVarious options exist for how to conduct a user study. As noted, the current article does not aim to verify or validate some complete solution in a formal lab experiment, which at the start would have been impractical and introduced many confounds . Rather what was desired was a way to explore important concepts and gain initial insight to refine the design, like a survey. A survey offers a practical, safe way to acquire information that would be difficult to obtain by observation in order to form generalizations, especially given restrictions due to the COVID-19 pandemic; demerits include unsuitability when an understanding of historical context is required, bias due to non-respondents (less educated people are less likely to respond), intentional misreporting, and difficulty that respondents can experience in assessing their own perceptions . Here thThus, as a first step in our ongoing work, a simplified user study was conducted using an online survey: The main part of the survey checked our assumptions about a generic strategy and acquired data to build a personalized emotional profile; additionally, some extra insight was obtained into how participants perceived art generated using a Wizard of Oz approach based on their profile obtained in the first part of the survey.21 adults at our university  participated in the first and main step of the survey. This included both faculty members and students in two computer science master programmes, such that all participants had at least an undergraduate degree in engineering or science. No members of our team, and no artists or art students, took part; and, participants received no compensation.In Sweden, according to the ethics review act of 2003, additional formal approval by an ethics council is required for “interventions using methods intended to physically or mentally influence” participants, (SFS no 2003:460) . Since tParticipants were sent links to a Google Forms survey , which t• Q1 Contingency: “The robot’s art fits emotionally with the human’s art .”• Q2 Creativity: “The robot’s art is creative.”• Q3 Desire to use: “I would like to do art with this robot.”In the survey, participants answered questions about the robot’s strategy for making art, then disclosed information about what symbols, representational or abstract, elicited emotions for them. First, for the robot’s strategy, the participants were asked to inspect three images. For each image, the participants imagined that a human and robot has made art together, with the human’s art depicted on the left side and the robot’s art on the right side of the image. Each image represented an interaction with one of the three different versions of the robot–exogenous, endogenous, and proposed–as shown in Thus, the technical term “contingent” was rephrased to be more easily understood by participants. In the second half of the survey, participants described which representational symbols and abstract colors and shapes made them feel happy, relaxed, sad, or angry. The participants were also given a chance to add free comments, which were then coded.The results were analyzed statistically. First, normality was assessed–which is a common assumption in some statistical tests–using Mardia’s coefficients for skewness and kurtosis . The asst scales . These tFor question 1 about contingency, median ratings were 5, 1, and 4 for systems 1, 2, and 3, the exogenous, endogenous, and proposed systems; a Friedman test indicated that the systems were perceived differently in terms of contingency, Likewise, the systems were perceived differently in terms of creativity for question 2, with respective median values of 2, 4, and 5; sidered) .Desire to make art with the robot also differed based on the robot’s strategy, with median scores 3, 4, and 5 for question 3; Thus, the basic premise of this work was supported: that a contingent and creative system combining exogenous and endogenous components might be more desirable as an art-making partner than a system which is only exogenous and contingent, or only endogenous and creative.Participants' self-disclosures about which symbols elicit emotions are collected in As expected, there was a high degree of variation in participants' responses: 433 labels were provided . The labels were grouped into 69 categories, whereof 21 were abstract (8 shape and 13 color), and 48 were representational. Only three abstract categories were mentioned by only one person each, compared to 28 representational labels mentioned only by one person each, such that 20 representational categories contained the vast bulk of these labels, or 179 labels. Thus, on average each participant provided 20.6 labels, whereof 9.9 were representational and 10.8 were abstract (for forms and colors), constituting a response rate of 2.5 representational and 1.3 abstract labels per question. For representational symbols, the most frequent symbols were sports, family, food and drink, nature for eliciting happiness; food and drink, visual leisure activities, and music for relaxation; failure and abusiveness for sadness; and abusiveness and injustice for anger. Thus, there was overlap: 10 of 20 symbol categories were reported by more than one participant for only one of the emotion categories, whereas the other 10 were reported for more than one emotion. Such overlap usually occurred between positive or negative emotions, rather than between aroused or relaxed emotions: For example, food and drink could be both happy and relaxing. Nature and family were considered to cause either happy, relaxed, or sad emotions; poor weather and missing family was associated with sadness. Failures in some cases could be related to work , but in general there were not enough details to link these two categories.For abstract symbols, out of 13 color categories, twelve (92%) were mentioned as eliciting both positive and negative emotions, and all 13 were considered to be both calm and aroused. The only exception was brown, which was only negative and calm (sad). White, black, and gray were explicitly described as eliciting every emotion, although if only colors mentioned by at least two participants are considered, this drops to only white. Also, some participants mentioned “warm colors” instead of specifying individual colors, but if this is taken into account, then red, yellow, and orange also encoded for all four emotions. Nine categories were furthermore described as eliciting three out of four emotions.The amount of overlap within individual participants' responses was also checked. Ten (48%) of the participants' responded in an overlapping way, in that one color could encode for more than one emotion , whereas the remaining eleven participants (52%) mentioned distinct colors for each emotion. In one extreme example, one participant wrote the same answer for all emotions: “graphite gray, black, white.”15 participants (71%) indicated more than one color for one or more emotions, whereof two participants listed more than one color for each emotion, and one participant listed eight colors that felt happy. In contrast, six participants listed at most a single color that made them feel each emotion, with two participants mentioning a total of three cases in which no colors could express an emotion.For shapes, there was likewise much variation and overlap. All categories mentioned by more than one participant (excluding “curved” and “everything”) were felt to elicit every emotion. Happiness was mostly shown by circles and diagonal lines, relaxation by horizontal lines and circles, sadness by squares and diagonal lines, and anger by triangles and diagonal lines. From the perspective of how each shape was perceived, circles seemed to be happy and relaxed, triangles to be angry, horizontal lines to be relaxed, diagonal lines were everything except relaxed (strongly showing various emotions), and vertical lines and squares seemed to be fairly uniformly spread out among the four categories.Seven participants (33%) reported that a shape category expressed more than one emotion.  Also, another seven participants (33%) mentioned two or more shapes for at least one emotion. Furthermore, four participants mentioned a total of eight cases in which no shapes could express an emotion.Along the way, it was also observed that there were more responses for positive than negative emotions, with some participants mentioning that all shapes seemed positive, possibly due to their engineering background, or giving no responses at all regarding negative emotions. Additionally, various references were made to personal information that was not provided through the survey: e.g., “my cat,” “my programming errors,” “my home,” “my brother,” “my child,” “my mom,” and “my parents.” Without knowing more, it is difficult to depict such symbols visually: for example, should “my cat” be depicted as a giant Norwegian Forest cat, or as a tiny Munchkin?The user study provided some general insight into how interactive art-making might be perceived, but left a question: Could personalized art based on self-disclosure more clearly convey emotions than using a general model? A concomitant challenge was that it was not clear if users would be able to accurately report which kinds of visually depicted concepts will best express various emotions to them. To gain some additional insight, four participants who completed the survey were asked to complete a follow-up survey . These participants were again sent links to a Google Forms survey, which was this time personalized. In total, the follow-up survey took approximately 10 min to complete.Paint.NET) . Personalized sketches were generated offline using the Wizard of Oz technique. The participants' responses were input into Google Image Search for images labelled free to reuse. To minimize the risk of using specific images that might communicate unintended signals, “clip art” was added to the search. For search queries where no appropriate image was found, synonyms were used. Images were manually selected to download and assembled into a single composition, before an art program effect was used as the last step to make the composition appear like a painting (int.NET) .The eight generic images were created once and used for all participants. Representational images were generated based on OASIS . The mosAfter generating the sketches, the participants were invited to complete the follow-up survey. This involved assessing 16 images  vs. art type  vs. four emotions). First, participants were asked to describe their current emotional state and if they had knowledge about art, to identify potential outliers; i.e., participants who were in an uncommon emotional state or who indicated high artistic knowledge that could involve strong preconceptions. Then the participants conducted four comparisons, once per emotion, in which they ranked the four images for each emotion  in order of how much the images expressed each emotion . Additionally, as a check to see how the participants perceived individual sketches, the Self-Assessment Manikin (SAM) was used to rate the valence and arousal of each sketch before comparisons ; the SAMThe first step in analysis was to identify potential outliers based on the preliminary questions about emotional state and artistic knowledge. One outlier was detected: in contrast to three participants who felt well, the remaining participant stated that they felt “depressed.” Furthermore, although none of the participants indicated strong agreement that they have artistic knowledge, the depressed participant’s self-rating was the highest in the group . Examination of the data from the depressed participant indicated some anomalous responses that appeared to be different from those of the other participants and general expectations from the OASIS dataset analysis, and possibly inconsistent and random: For example, the sketch of a small puppy selected by the participant as the happiest of the four images in the comparisons was rated as highly negative via SAM. The generic sketches of an injured bleeding person, as well as the sad and angry generic abstract sketches, were assessed with the most positive score possible. Additionally, a pattern could not be seen in the comparisons, with a different category considered to best express emotion each time. Thus, although there might have been some effect related to artistic preferences, or some external factor such as time pressure, the inconsistencies might have been unintentional due to feeling depressed, which can involve anhedonia and negative fixation .Based on this, the data were analyzed in two steps, both with and without the outlier data (4 vs. 3 participants). Using all of the data, the personalized representational art was most frequently described as best conveying the intended emotions ; and, a Chi-squared test with Yates correction confirmed that the participants seemed to perceive the systems differently . Furthermore, the robot uses a person’s self-disclosure with representational symbols to personalize its art, which seemed to be easier to use and clearer than abstract symbols for the current context.Specifically, before the interaction, a person answers some questions about which symbols elicit their emotions. Then the robot starts the interaction with a quick introduction, asks the person to draw a grass field, and records an image of the person’s painting. This analysis results in a judgement if the person’s painting is happy or sad, based on features such as intensity, color, and shapes, as described previously. Then, the robot seeks to express contingency and creativity by painting a different natural scene  with a similar emotional feel. Although highly simplified, this interaction brings together some of the concepts discussed in the current article on emotional contingency, creativity, general norms, and personalization, which is also illustrated in a short video demonstration .In summary, the current speculative article used a collaborative prototyping approach, including a small user study, to propose a design for a robot to paint with a person in a contingent, creative, and desirable manner, based on personalized visual metaphors. General strategies and personalization are discussed below, followed by identifying some limitations and challenges for future work.• Overall: A central finding in this article was that participants preferred to make art with a balanced system that is both contingent and creative.• Representational: Also, a small number of 20 frequent categories was identified for representational symbols; the categories most associated with emotions seemed reasonable, because positive effects of physical activity, affection, diet, music, nature, and hobbies are well-known, as well as negative effects of failure, abuse, and injustice. • Abstract: Some general patterns were also identified for abstract symbols. For colors, the idea that white, black, and gray could express various emotions was not surprising, as black and white art, comprising various shades of gray, is common in media such as comic books, which have been used to express a full gamut of emotions. The association of brown with sadness, although unexpected, also made sense, as brown is a composite color comprising yellow and red with black, which can be thought of as dark orange, and darkness is associated with negative emotions like sadness. However, responses about the emotional meanings of colors did not always agree with Ståhl’s color model; for example, colors in the negative quadrants like purple were considered also to be happy. This could indicate a cultural influence, or a more complex association of a range of various saturations, intensities, and hues with such labels–regardless, it also suggests that such generic guidelines should be taken with a grain of salt, and that personalization can be useful.Some patterns could be identified overall and for representational and abstract art:For shapes, the finding that circles seem to be positive and triangles to be negative is supported by previous experiments . Likewis• Overall: A central finding was that personalized representational symbols seemed easier to use and clearer than abstract symbols.• Easier to use: Participants disclosed more information about representational than abstract symbols , possibly because fewer abstract categories exist. Furthermore, although all participants were able to describe representational symbols, some participants were not able to describe colors or shapes that expressed an emotion.• Clearer: Representational symbols also seemed to be more monosemic, and have less overlap between positive and negative emotions than abstract symbols. It seems encouraging that 10 typical categories, and 28 one-label categories, were uniquely tied to one emotion, suggesting that such emotional communications will be perceived as intended. As well, there is some ambiguity associated with abstract symbols; for example, a circle could remind someone of either positive symbols like an angel’s halo, candy, or a soft pillow, or negative symbols like a pit, an open garbage can, or a shark’s mouth gaping wide to violently rip into its prey. Intuitively, this seems to be supported by how humans interact in everyday conversations: when someone asks how we are, we usually mention specific experiences, like doing well on an examination or feeling bad due to a cold; we don’t usually talk about feeling good or bad due to a color or form. Additionally, the small follow-up survey appeared to indicate that for some participants, self-disclosure can be used to better communicate emotions through personalized representational art, rather than personalized abstract art or generalized representational art.A Folksonomic-style model was used to gather 20.6 self-disclosed labels per person (433 labels for 21 people) for personalization, avoiding the need to know ahead of time what categories to use; participants' self-disclosed perceptions of emotions in art were observed to be highly idiosyncratic and varied greatly–in line with previous work.• Explorative results. These results are limited by the speculative, exploratory approach. As noted, the current article was not intended to provide some final answer as to how robots can interact with people in an emotional and creative way; rather, the aim was to explore some early stage ideas for such a design and stimulate discussion that could aid the design of a variety of future systems, as in some previous articles that have followed a speculative design approach . In the • Practical and technical challenges. Prototyping indicated that a current bottleneck is timely generation of novel images that does not require a human in the loop to identify appropriate images to paint; smaller problems include noise in real human environments related to lighting and motion, as well as a seeming lack of easily reusable code for painting robots to render images, possibly due to the high diversity of robot morphologies.• Abstract art. Another challenge is that it seemed more difficult to personalize abstract art than representational art. Three potential causes suggested themselves: 1) Personalized preferences for abstract art often overlapped with general guidelines–e.g., red and black colors with diagonal lines to represent anger–whereas, the space for representational art is much more expansive; for example, no participant described the contents of the generic image, a small puppy in a cup in a grass field, when queried for a happy symbol. 2) Another potential cause is that the participants might not have known ahead of time what kind of abstract art would make them feel a certain way, which was indicated in some comments. 3) Finally, our measurements in the sparse, open-ended survey might not have been sufficient to model participants' preferences. For 2), a reflective approach to personalization, intended to empower users by querying to encourage thought about goals before starting an activity, might be useful . Anothe could be• Difficult individuals. Some participants seem to be easier to make art for than others; specifically, participants who listed more representational symbols, colors, and shapes that elicit emotions, while not using the same symbols for multiple emotions, and providing sufficient information to be able to visually depict images: Typically, paintings use more than one color or shape, so it might be easier to prepare art for participants who listed more options. Likewise, it might be easier to express emotions in artwork for participants who did not say that one color or shape expressed multiple emotional meanings to them. Additionally, some participants referred to personal information, like “my family,” which alone could be insufficient for visual depictions. Another challenge was noted with the seemingly inconsistent appraisals by the depressed participant; in a therapeutic context, robots will probably frequently interact with people with depression; therefore, such persons should not be excluded or marginalized, but rather centralized in at least some human models.Next steps will include conducting more rigorous user studies, overcoming practical challenges, dealing better with some people who for whom personalization seems to be more difficult, improving personalization of abstract art, and exploring other applications:• Other applications. The concepts here could be applicable to other kinds of art, from sculpture to photography, drawing, and other crafts. Moreover, the usefulness of ensuring a balance between exogeny and endogeny, and thereby emotional contingency and creativity, might not be restricted only to painting robots; rather a similar pattern might be useful for interacting with humans in various contexts, such as advertisement, writing, music, and games. For example, the author of the current article was part of a team that set up an android in a department store as a kind of lifelike, moving mannequin in a Valentine’s Day display for two weeks in February 2012  ; the andTo acquire better data, motivation can be clarified for those participants who responded with only few or overlapping labels: Was there an underlying difference in how they perceive emotions in art or some other confounding reason , or were some tired of the survey and trying to get it done fast)? Survey instructions could then be refined, gaps could be caught at the time of profile creation, or a robot system could query afterwards for more information, although in any case there is a need to be careful about ethics in treating personal information. To determine if a painting will be able to correctly convey an intended emotion to someone who is depressed, one way to seek to avoid miscommunications might be to use a multimodal strategy to better detect and convey emotions: in addition to analyzing art, a robot can check a person’s emotions via a Brain-Machine Interface, and verbally ask for confirmation that these emotions have been correctly identified, before describing its intentions as it paints.Consideration of such topics could allow such robots to exert a positive influence on interacting humans.• General: participants would prefer to make art with a robot that is both emotionally contingent and creative, rather than merely one or the other, which can be done by balancing exogeny and endogeny; also, some shared patterns could be identified for both representational and abstract symbols, such as that personalizable symbols such as sports, food, family, and nature are perceived in a positive way• Personalized: participants' self-disclosed perceptions of emotions in art were highly idiosyncratic and varied greatly, in line with observations in previous work, suggesting also that some participants' perceptions might be easier to model than others; also, representational symbols appeared to be easier to use for personalization than abstract symbols, in terms of encouraging more disclosure, being less ambiguous and more easily related to individual emotions, and seeming to more clearly convey emotions in some sketches.This article suggested the “smart phone hypothesis,” that social robots will become accepted into various human environments when they become capable of interacting in a variety of useful ways, including within challenging applications involving emotions and creativity, like art-making. A speculative approach involving collaborative prototyping with artists and engineers, along with a small user study, provided some insight into practical challenges such as timely autonomous image generation, as well as general strategies and personalization:These results were discussed with the aim of stimulating ideation, which included proposing some next steps in terms of reliability, practicality, challenging cases, art forms, and other applications.The basic contribution is insight into some considerations for art robots that could help to support well-being in interacting people. At a higher level, exploration in this research direction could potentially facilitate technological acceptance for robots in human spaces, and also eventually provide an opportunity for us to learn about emotions and creativity, two phenomena which are tightly intertwined in our natures as humans.


There is limited evidence of Aboriginal and Torres Strait Islander people attending cardiac rehabilitation (CR) programs despite high levels of heart disease. One key enabler for CR attendance is a culturally safe program. This study evaluates improving access for Aboriginal and Torres Strait Islander women to attend a CR program in a non-Indigenous health service, alongside improving health workforce cultural safety.An 18-week mixed-methods feasibility study was conducted, with weekly flexible CR sessions delivered by a multidisciplinary team and an Aboriginal and/or Torres Strait Islander Health Worker (AHW) at a university health centre. Aboriginal and Torres Strait Islander women who were at risk of, or had experienced, a cardiac event were recruited. Data was collected from participants at baseline, and at every sixth-session attended, including measures of disease risk, quality-of-life, exercise capacity and anxiety and depression. Cultural awareness training was provided for health professionals before the program commenced. Assessment of health professionals’ cultural awareness pre- and post-program was evaluated using a questionnaire (n = 18). Qualitative data from participants (n = 3), the AHW, health professionals (n = 4) and referrers (n = 4) was collected at the end of the program using yarning methodology and analysed thematically using Charmaz’s constant comparative approach.Eight referrals were received for the CR program and four Aboriginal women attended the program, aged from 24 to 68 years. Adherence to the weekly sessions ranged from 65 to 100%. At the program’s conclusion, there was a significant change in health professionals’ perception of social policies implemented to ‘improve’ Aboriginal people, and self-reported changes in health professionals’ behaviours and skills. Themes were identified for recruitment, participants, health professionals and program delivery, with cultural safety enveloping all areas. Trust was a major theme for recruitment and adherence of participants. The AHW was a key enabler of cultural authenticity, and the flexibility of the program contributed greatly to participant perceptions of cultural safety. Barriers for attendance were not unique to this population.Trial registration: Australian New Zealand Clinical Trials Registry (ANZCTR) 12618000581268, http://www.ANZCTR.org.au/ACTRN12618000581268.aspx, registered 16 April 2018.The flexible CR program in a non-Indigenous service provided a culturally safe environment for Aboriginal women but referrals were low. Importantly, the combination of cultural awareness training and participation in the program delivery improved health professionals’ confidence in working with Aboriginal people. The online version contains supplementary material available at 10.1186/s12872-021-02016-3. Cardiovascular disease (CVD) is diagnosed in almost half of Aboriginal and Torres Strait Islander people aged 55 years and over, and is the largest cause of premature death in this population . CVD is It is widely recognised that cardiac rehabilitation (CR) improves cardio-metabolic risk profiles, decreases hospital admissions, increases medication adherence and improves quality-of-life in those diagnosed with coronary heart disease –9. CardiDespite these barriers, CR programs have been implemented for Aboriginal and Torres Strait Islander populations, primarily in Aboriginal Medical Services (AMS) , 18. TheOne of the key enablers for Aboriginal and Torres Strait Islander CR attendance is the provision of a culturally safe program, preferably delivered within an AMS , 19. Cul(i)evaluate the feasibility of a centre-based women’s Aboriginal and Torres Strait Islander CR program in a non-Indigenous health setting.(ii)investigate a combination of strategies to improve cultural safety in a non-Indigenous healthcare setting.The aim of this study was to implement known enablers, including the provision of a culturally informed gender-specific program, to overcome common access barriers for participation in CR programs in a non-Indigenous health service for Aboriginal and Torres Strait Islander women. Specifically, the two distinct aims were to:The mixed methods cohort feasibility study was conducted from February to December 2018 at a University Health Clinic.Yeddung Gauar’, meaning ‘Good Heart’.The CR program draws on the idea of restorative healthcare, framed using restorative practices defined as “a philosophy, in action, that places respectful relationships at the heart of every interaction” . This reThe evidence-based enablers incorporated into this program included an AHW, provision of transport assistance, and exercise and education sessions delivered in a gender specific, culturally safe, structured, yet flexible CR program in a non-hospital setting –19.Environmental changes to support cultural safety included visual displays representing Aboriginal culture  within the University Health Clinics . AborigiThe CR program used a multidisciplinary team approach, including exercise physiologists, physiotherapists, dietitians, psychologists, pharmacists, supervised university health students and an AHW. The CR program was a 6-week rolling program, conducted once a week for 18-weeks (June-October 2018), consisting of 1-h exercise and 30-min education sessions. Attendance was flexible and participants were not required to attend 6-consecutive weeks, however, participants were encouraged to complete 6 sessions or more during the 18-week period. Participants were re-assessed after every sixth session attended and continued on in the program following this assessment for the remainder of the 18-weeks, if desired. The main aim of the individually tailored exercise sessions was to increase cardiovascular fitness, involving exercise at a moderate intensity . The eduFemale Aboriginal and Torres Strait Islander adults (≥ 18 years old) were eligible for inclusion in the CR program. Participants were included if they had stable heart disease and were receiving optimal medical treatment + / − revascularisation, had experienced a heart attack, or if they were at medium-to-high risk of developing heart disease according to the Absolute Risk Calculator , 38. If The program was advertised in local media  and on the internet  from April to September 2018. Participants could self-refer or be referred by a health professional. Additionally, members of the research team and the University Elder-in-residence contacted key stakeholders such as the local AMS, Aboriginal and Torres Strait Islander health services, general medical practices, Aboriginal community groups and local hospitals. The research team also attended local Aboriginal and Torres Strait Islander events to promote the program. All potential participants were approached by the AHW initially to assess eligibility, interest and ability to commit to participating in the rolling 6-week program.Initial assessments and collection of baseline measurements, including obtaining written consent, for all participants were conducted one week prior to the commencement of the program. Assessments were repeated every sixth session attended. Demographic and clinical information was recorded to describe the sample such as age, education level, relationship and employment status, health conditions and medication use.2); waist and the hip circumference; resting blood pressure; random point-of-care lipid and glucose measurements  one of the ladies would do her shopping on her own…You know, walking around the supermarket, and then stopping, having a rest, getting up, going, that’s an achievement.’ ‘I’ve really enjoyed coming to the program, I’ve learned a variety of things. How to maintain doing exercise with healthy recipes for cooking and stuff like that.’ Participants enjoyed implementing and maintaining the exercise and diet recommendations. There were positive outcomes, such as, being able to walk longer distances with less effort and cooking healthier foods at home, improving their diet.‘she’s never lost any weight with us so we knew that wasn’t going to happen quickly…So you’ve obviously stimulated her somehow to get her moving. The weight loss, the weight loss is something that doesn’t happen easy.’ One of the referrers found that a participant had lost weight which had not been achieved with multiple previous visits to their service.The AHW and health professionals reported participants felt empowered, they’d achieved something and it increased their personal motivation or self-efficacy. Participants, health professionals and the AHW all felt that the participants’ health literacy had increased and they were feeling more confident to question health professionals and seek advice on their health. Participants also enjoyed educating other family members about what they had learnt in the program.p = 0.04). No other significant changes were found. On average, participants agreed that the rate of Aboriginal people developing diabetes and presenting to hospital with heart disease was approximately 3–4 times more than non-Aboriginal people.Eighteen health professionals and administrative staff completed the cultural awareness questionnaire at baseline, before the cultural awareness training, and eleven at 18-weeks Table . Nine ba‘having her there was important for the participants…it was in a way bridging the gap. If she wasn’t there then the adherence to participants turning up may have been affected…I think it’s got to do with the respect or the trust that participants will have in accessing services.’ Participants and health professionals felt that the program increased the knowledge, skills and confidence of the health professionals in working with Aboriginal patients. Health professionals, the AHW and participants said the AHW involvement was crucial, they were seen as a navigator of the program for the Aboriginal women.‘I found that it was little bit different in the sense that you could be a little bit more open with them, because the more open that you actually are, the more open they are. So I found that I needed to just be in a way a little bit more casual in a way sometimes, because they’d ask questions and you’re just like, “Oh, that’s,” you know I wouldn’t normally speak about [my] family, because they are massive on family, but I would normally not speak about [my] family with clients… At first I was a bit hesitant, because obviously you know we were taught basically to keep it professional, so opening up in that sense was a little bit more vulnerable.’ The AHW suggested health professionals need to get to know Aboriginal people individually, to improve their interactions. Health professionals learnt to be more open, more casual and talk more freely about their family which they wouldn’t normally do in a patient interaction.‘I found the participants, it took a bit of time to actually warm up and I guess trust and build that rapport with them, and then once that developed then it was much easier to interact with them, and then for them to trust me with the program that I had recommended.’ Health professionals found it took time to gain the trust of the participants and build rapport.Health professionals said they needed to recognise their own culture and the culture of the patients, including allowing time for silence. They also found that analogies worked well, particularly connecting with the land.‘Yes, I think it just made me a little bit more comfortable. So not having a lot to do with Indigenous people, I just didn’t, you know it was a bit I thought, well do I say the wrong thing? But once I got to know them and realised that I didn’t have to be frightened about what I said, well you know I wasn’t… you know with any group you’re careful what you say, but I’ve certainly felt that I was, you know, able to… and once I’ve met them. So having that initial information and understanding of the background, and where, what’s influencing, you know, people’s behaviours, I thought that made it a lot more easier’ Health professionals reported that the cultural awareness training increased their confidence with interactions with Aboriginal and Torres Strait Islander people.‘maybe every one or two years have the opportunity to attend something like [cultural awareness training], because it’s kind of like first aid, you learn something new every time you go, no matter how much you’re like, oh, I’ve done this before.’ Health professionals, referrers and the AHW recommended that attendance at cultural awareness training sessions should be repeated and not completed once only, similar to other mandatory workplace training, and the AHW suggested that cultural awareness training alone was not enough.‘OK, I’ve done the mainstream program, well I was put into it, at a point. Because I missed an appointment, because something came up, some sorry business came up. And because I missed that appointment, they just cancelled the rest of the appointments.’  Referrers, the AHW and participants discussed participant’s previous negative experiences with institutions and health professionals, reporting feelings of shame, guilt and judgement.‘It was a relaxed environment. It wasn’t rigid. Like I’ve said before, there’s been in mainstream, when you go there, you feel like you’re carrying guilt for being sick in the services. So here was, we could come in, if we were a bit off, they left us to do what we had to do. Didn’t question us.’ ‘I mean people aren’t going to go to…like the shame and guilt, you know, we’re our own worst enemies, if we don’t turn up to something we feel guilty’ The flexibility of the program was greatly valued as this lessened the feeling of guilt if participants were unable to attend every week.‘I do think having a capacity for people to not feel like if you don’t attend for your six weeks you miss out…I think that works really well, but it also doesn’t necessarily lead to great buy-in if you know that you can just turn up at any time. So I don’t know if there’s a way to find that middle ground…’ Although some health professionals thought the flexibility of the program may not encourage consistency.‘you saw that real connectedness in just participants… that just made me realise that you’re actually working with a very connected community’ Health professionals and referrers felt they needed to recognise that they were working with individuals where family and community would always come first.Allowing children (< 18 years old) to attend the program was very valuable to health professionals and participants, allowing family sharing of both participants and health professionals and a personal connection.‘black faces’, and being Aboriginal and Torres Strait Islander specific was a positive. The program differed to a mainstream service and was not time limited.‘ [the] program was incredible, especially having Aboriginal women there supporting you, like [the AHW]… So even just having that space to yarn, it was good.’ Participants felt this was a safe and comfortable environment, with ‘I don’t think people really take that much notice of it. I think… I don’t know whether people are sort of used to seeing Aboriginal artworks around, and maybe they just don’t [notice it]… But it definitely needs to be acknowledged, that’s for sure.’ Some health professionals felt that a culturally safe space was provided by introducing Aboriginal and Torres Strait Islander flags and artwork but some health professionals did not notice this.‘if they’re not promoting it, is it really for our mob?’ Some referrers suggested that potential participants did not want to go to the AMS, while others felt that AMS endorsement was important. Elder guidance and endorsement of the program was viewed as very important.Referrers, participants and the AHW all agreed that cultural considerations are important, particularly taking into consideration that heart problems can occur in younger people in the Aboriginal community. The resources provided were thought to be culturally appropriate by the health professionals and referrers, although they were not tailored for all participants, particularly younger participants. Health professionals questioned whether the program needed to be gender specific, while the AHW, participants and referrers thought this was a positive for the program.The Yeddung Gauar program created a culturally safe space for Aboriginal women using a combination of strategies to address non-Indigenous health professionals’ knowledge, awareness, behaviours, skills and attitudes. Participants felt that the health service environment was comfortable and safe, where they were not judged, and lessened feelings of guilt connected with previous experiences within the mainstream healthcare system. Health professionals’ knowledge, skills and confidence in working with Aboriginal people improved following attendance at the cultural awareness training and involvement in the program. However, issues such as recruitment methods need to be addressed to increase community trust and referrals to similar programs.It is clear that cultural awareness training alone is not sufficient to improve cultural safety . This isThemes of relationship and trust building, and unconditional positive regard towards attendees, with no judgement were strong and contributed greatly to cultural safety, from the participants’ perspective. This may have contributed to the adherence to the program, with all participants attending > 65% of the sessions available to them, higher than other rates of attendance previously reported in Aboriginal specific CR programs . Health As part of the program non-Indigenous health professionals recognised how important family and community were to participants. Hence, non-Indigenous health professionals’ need to be cognisant that the Aboriginal definition of health (life-death-life) differs from the Western view of absence of disease. Aboriginal health means not just the physical well-being of an individual but refers to the social, emotional and cultural well-being of the whole Community in which each individual is able to achieve their full potential as a human being thereby bringing about the total well-being of their Community, with less focus on the individual .The known enablers to increase participation in CR for Aboriginal and Torres Strait Islander peoples that were utilised in this program such as the inclusion of an AHW, provision of transport and a culturally safe environment, and a gender-specific flexible program reinforced the value of such factors, with all them found to be major enablers for the Yeddung Gauar program, resulting in positive changes in health outcomes –19. ThesAn important learning from this research was that although included as an investigator in the study, the leadership of an Aboriginal Traditional Land-owner and Elder could have been utilised more effectively in the co-design, management and leadership within the program. A barrier to success was noted to be the traditional colonised and hierarchical approach to research and health systems that does not take into account the cultural connection to Country, and respect and leadership power that Traditional Land-owner Elders hold in their local community. It is critical to be aware of Aboriginal protocols so as not to offend Aboriginal people. It is vital not to diminish the role of Traditional Owners in understanding the diversity that exists across each of the Aboriginal nations and respecting the difference between knowledges held in each First nation. Non-Indigenous researchers must practice cultural humility to have success and be alert to the reality that Aboriginal and/or Torres Strait Islander Health Workers who are not from the same Country need support and guidance from Elders who are Traditional Owners to successfully engage with the Aboriginal community they are working within. Non-Indigenous researchers and health workers need to respect the Elders guidance and leadership for trust to grow. Elders are leaders who are respected and followed by their community and will actively encourage participation when actively engaged. Using approaches that ensure cultural sensitivity, respect and voice of Traditional Land-owner Elders to guide the work and ensure all team members are respected will enhance future programs. In the gifted words of the United Ngunnawal Elders who supported this project, “In this Journey we strive for unity. We do this by empowering people, creating confidence, self-esteem and room for difference, so we can work and laugh together, moving forward all the while” .Three of the research team are First Australians . Researchers from physiotherapy and nursing with experience in Indigenous health, cardiac rehabilitation and restorative practice have also been involved in this research. An important strength of this study is the deliberate privileging of Aboriginal and Torres Strait Islander voices at all levels of the research strategy, applying restorative healthcare practice principles, an ontologically appropriate strength-based approach for this study with foundations in First Nations practice , 55. TheThe Yeddung Gauar cardiac rehabilitation program enabled female Aboriginal and Torres Strait Islander participants to attend a gender-specific evidence-based cardiac rehabilitation program, for the primary and secondary prevention of heart disease. This program was effectively delivered in a non-Indigenous health service by engaging in strategies that improved health workforce cultural safety and resulted in positive health outcomes. Future programs in non-Indigenous health settings should employ similar strategies and cultural learnings to increase cultural safety, recognising the evidence-based enablers and barriers for cardiac rehabilitation attendance for both Indigenous and non-Indigenous Australians.Additional file1: Health professionals cultural awareness questionnaire.Additional file2: Yarning circle topic guide.Additional file3: Semi-structured interview topic guide.