The Role of Cultural Institutions in Promoting Well-Being, Inclusion, and Equity among People with Cognitive Impairment: A Case Study of La Pedrera—Casa Milà and the Railway Museum of Catalonia

Abstract

Background: Museums and cultural institutions are increasingly aware of the needs and interests of the society they serve. Simultaneously, these institutions play a more significant role in public health and well-being, such as by conducting activities for people with cognitive impairment. Moreover, they prioritize their contribution to achieving the Sustainable Development Goals set by the United Nations within the framework of the 2030 Agenda, thus connecting both objectives. Method: A comparative case study was conducted to determine how the characteristics of cultural institutions conducting activities for individuals with cognitive impairment can affect their outcomes and promote well-being, inclusion, and equity. Data-collection techniques included non-participant observations, interviews, and document reviews. Results: This research suggests that certain characteristics of cultural institutions can influence the management and execution of cultural activities aimed at people with cognitive impairment, as well as their ability to promote well-being, inclusion, and equity. Conclusions: The characteristics of cultural institutions influence the management and execution of cultural activities aimed at people with cognitive impairment, as well as their impacts and benefits. Collaboration between diverse institutions enhances outcomes, promoting well-being, inclusion, and equity among participants.

1. Introduction

In a world with increasing cultural awareness, museums and cultural institutions have become highly valued as allies and leaders in advocating for and promoting well-being, social awareness, and sustainable development [1,2,3,4].

Society has shifted its attention to focus more on inclusivity and social responsibility, and consequently, museums and cultural institutions have become committed to the achievement of Sustainable Development Goals (SDGs) [3]. For instance, in 2016, a meeting of museum leaders took place in Catalonia to explore how museums and cultural institutions could enhance social inclusion, highlighting the importance of considering accessibility, equity, and well-being in their activities. This meeting was organized by the International Council of Museums (ICOM) together with the La Caixa Foundation. It showed how different institutions had successfully implemented programs aimed at promoting social inclusion, equity, and well-being among different demographic groups, including older people and especially those who live with cognitive impairment (CI) [5,6,7,8,9,10,11].

The world is currently facing formidable challenges as a result of our lifestyle [1,2,3,4]. The increase in life expectancy in Western societies can be linked to how more people now live with conditions and diseases related to old age, such as Cognitive Impediment (CI) in general or dementia in particular [12]. Similarly, the number of people affected by conditions and diseases related to old age is growing exponentially, and therefore, there is a large demographic of elderly people [13,14]. The inverted demographic pyramids of several first-world countries are also a result of a drop in the birth rate [15]. According to the World Health Organization (WHO), the number of aged 60 years and older will be 2.1 billion by 2050 [16]. At the same the number of people who have dementia is estimated to be 152 million by the same decade, tripling since [17].

This paper will analyze whether the premises, financial resources, prestige, and reputation of the institutions can affect their potential impact on particular Sustainable Development Goals (SDGs). The specific focus of the study will be the activities aimed at individuals with CI to outline the role museums have in promoting social inclusion, equality, and well-being [18] while considering their social function [1,2,19]. Ultimately, the research seeks to investigate the relationship between the characteristics of cultural institutions and their cultural activities aimed at a particular audience to provide valuable information for museums as well as cultural and public policy professionals striving for a more equal and sustainable society.

This research uses a qualitative approach, specifically a comparative case study method, as cited in other studies of various topics, giving it added validity [20,21]. It is based on non-participant observation, semi-structured interviews, and documentary reviews. This approach was chosen to explore in depth the relationship between the characteristics of institutions, the management and development of cultural activities aimed at people with CI, and their impact on well-being, equity, and inclusion.

The investigation hypothesis is that there is a correlation between cultural institution characteristics and how they manage and develop their cultural activities. At the same time, it is expected to reveal a significant relation between how the management and development of these activities affect the well-being they provide to the participants as well as their degree of equity and inclusion. On the other hand, it is important to highlight that this research focuses on analyzing the characteristics of cultural institutions and the aforementioned correlations among Catalan cultural institutions. Catalonia is recognized as the Spanish region with the most cultural institutions conducting activities aimed at people with CI [22]. The analysis in this limited regional context allows a detailed examination of both selected cases.

The principal objectives of this study are to understand how the characteristics of cultural institutions affect the logistics of activities to include people with CI and promote social inclusion, equality, and well-being—concepts related to specific SDGs [23,24]. Ultimately, this research aims to provide key information for those professionals in the political and cultural sector in charge of promoting inclusion and sustainability.

Research Area

Spain is a country known for its rich cultural heritage [25,26]. Moreover, in recent years, many of its cultural resources have decided to take a more active role in terms of health, well-being, equity, and inclusion [27,28,29,30,31,32]. In addition, an increasing number of cultural institutions started to offer special programs or activities for people with CI. The map below, provided by CCCB, shows the activities offered in 2018 around the various Spanish territories [22]. As can be seen in the map (see Figure 1), Catalonia, a region in northeastern Spain that receives a significant number of tourists [33], has proved to be a fertile ground in terms of cultural activities aimed at cognitively impaired people. Already in 2018, it was the region with the most cultural activities aimed at this specific public. The map is the most up-to-date one produced at a national level regarding cultural activities aimed at people with CI.

Presently. all the museums registered in Catalonia are included in the inventory of health assets [34]. As can be seen on the following map (see Figure 2), there are currently 35 active activities aimed at older people if we search with the keywords museum and restrict the search to activities aimed at people older than 64 years old. Of the 35 activities that appear in the map of initiatives linked to health and well-being that are carried out in museums and heritage spaces in Catalonia, 19 are aimed at older people with CI. Thirteen of these 19 initiatives are directly linked to the REMS (Memory Reinforcement) program.

The REMS program is a memory reinforcement program led by the Catalunya La Pedrera Foundation. This private foundation focuses on improving the quality of life of people in different areas. Its headquarters are in one of the most emblematic buildings of Barcelona’s modernism, La Pedrera—Casa Milà. Therefore, its relationship with culture and heritage is inherent.

For the comparative case study, within the different cultural institutions related to the REMS program, the following two institutions have been selected due to their differences and particularities (see Figure 3). La Pedrera—Casa Milà has been chosen as the flagship of the program because it possesses the characteristics of large institutions. On the other hand, The Railway Museum of Catalonia has been selected for being a museum with a local character and very different characteristics from the other institutions, which helps to give visibility to these smaller institutions that are often underrepresented in the scientific literature.

2. Background

2.1. The Sustainable Development Goals

The United Nations General Assembly proposed the SDGs in the 2030 Agenda for Sustainable Development, which was adopted by all United Nations Member States in 2015. The SDGs are an intentional response to one of the main challenges currently facing humanity: sustainable development [35].

As a result of over two years of public consultation and engagement with civil society and stakeholders, the 2030 Agenda established 169 targets and 17 main goals, aiming to stimulate action to achieve the objectives over 15 years.

Despite the global scale of such a broad and universal policy agenda, each country has primary responsibility for its economic and social development, and national parliaments are accountable for the effective implementation of the objectives of the 2030 Agenda.

Although the main objective of the 2030 Agenda is to eradicate poverty, there are other objectives to be achieved that transversally affect all the organizations and institutions that make up our modern society. These include the promotion of health and well-being, as well as the reduction of inequality and improvements in inclusion—and this is where museums and cultural institutions can play a key role [3,4].

2.2. Cognitive Impairment

CI is a condition encompassing a wide range of medical issues [36]. The symptoms range from a general deterioration of intellectual function, memory loss, and difficulty learning new things and concentrating to other symptoms such as aphasia, delirium, confusion, or even amnesia. As symptoms worsen or become more frequent, they may affect daily life activities and decision-making [37].

The causes of CI can be as diverse as frequent use of toxic substances, traumatic brain injury, medication side effects, lack of vitamins, dehydration [38,39], or a pre-existing syndrome such as dementia [12]. In fact, dementia is a term to describe a syndrome commonly found in neurological conditions associated with a continuous decline of mental function, and it is the most frequent cause of CI [12,40].

Presently, more than 55 million people worldwide are living with dementia. It mostly affects the elderly, and it is one of the main reasons for dependency in that group [41]. Alzheimer’s is the most common type of dementia and the cause of almost 70% of cases of dementia [42,43]. Furthermore, dementia is the seventh leading cause of death globally and has a significant economic cost [44,45], especially considering it is a syndrome with no known cure.

Due to the extent and impact of CI, particularly with dementia as its main cause, it deserves special attention as a public health issue. It has become one of the main global health challenges as the number of affected people is constantly growing [12,42,46]. Therefore, any possible improvements in the well-being of those affected must be considered, and this is where museums and cultural institutions can become potential allies in the health sector [2,18,47].

3. Materials and Methods

This paper uses a comparative case study. It adopts this research method as the case is compared and contrasted with other cases [20].

This method has been chosen as it is the most appropriate to investigate how the characteristics of the cultural institutions conducting cultural activities aimed at people with cognitive impairment can contribute to the achievement of SDGs 3, 10, and 11. These SDGs were considered to be related to cultural activities for people living with CI. Using the comparative method allows us to identify variables that may be similar or different in each case study. Furthermore, by comparing fewer cases, better results can be obtained by avoiding context diversity.

The comparative analysis of several case studies can be understood as a qualitative methodological approach that allows us to comprehend social phenomena as well as the human behavior associated with a specific context [20].

For this multiple case study, non-participant observation, interviews, and documentary reviews were used as data-collection techniques. The use of more than one technique to collect data allows us to gain a more accurate understanding of each case.

The qualitative methodological approach was applied to each of the cultural institutions. This methodology is based on the triangulation of information collected from different evidence sources, which in this project were non-participant observations, semi-structured interviews, and documentary reviews.

For the comparative study, significant factors to consider were the premises, financial resources, prestige, and reputation of the cultural institutions, which could affect how they carry out cultural activities aimed at a specific audience to achieve particular SDGs.

3.1. Data Collection

The two cultural institutions chosen as case studies to compare and analyze are The Museum of The Railway Museum of Catalonia and La Pedrera—Casa Milà. In the case of La Pedrera—Casa Milà, we are focusing on a specific temporary exhibition (from 31 March 2023 to 23 July 2023) by the artist Jaume Plensa, entitled The Poetry of Silence.

Both institutions collaborated with the REMS program of the Catalunya—La Pedrera Foundation. This foundation is the owner of La Pedrera—Casa Milà and it is very committed to improving the quality of life of different groups of people.

The acronym REMS, in Catalan, stands for Programa de Reforç i Estimulació de la Memòria i la Salut, which in English would be Memory and Health Reinforcement and Stimulation Program. In this program, tools and strategies are provided to individuals with dementia to enhance their emotional well-being, help them maintain their residual skills, and preserve abilities while offering them a better quality of life. The REMS program is part of a larger program called Dignified Aging.

1.

Non-Participant observation of REMS program taking place at both La Pedrera—Casa Milà and The Railway Museum of Catalonia. The observations focused on participants’ well-being, accessibility of the museum building, collections, and exhibitions, as well as the resources both available and used. Some other factors that were observed in detail were the interdisciplinarity of the professionals who took part in the activity and how this affected the development of the practice that was carried out, as well as how facilitators were able to personalize the experience to the specific participants that were taking part in the activity at any given moment.

The precision of data collection and interpretation increased by adopting this observational approach and being aware of the community as well as the sociocultural context [48,49].

2.

Semi-structured interviews were carried out with professionals at La Pedrera—Casa Milà and The Railway Museum of Catalonia, discussing how the characteristics of the institution they belong to affect the development of the cultural activities aimed at cognitively impaired people and the achievement of the related SDGs. It should be mentioned that although Pedrera—Casa Milà professionals carry out their professional activities at La Pedrera—Casa Milà, they are employed by Catalunya La Pedrera Foundation. Their perspectives on running these cultural activities will also be included, as well as the successes and failures they have experienced over the years. Semi-structured interviews allow us to delve deeper while contextualizing the responses to the specific context the professional belongs to [50,51].

3.

Documentary review of official sources of both cultural institutions La Pedrera—Casa Milà and The Railway Museum of Catalonia. This review allows us to gather relevant information in an accurate way to gain a better understanding of the operation and management of both institutions within the research context.

3.2. Instruments

Semi-structured group interviews with a pre-prepared guide were carried out [50,51] to obtain more in-depth information about the activities of people with CI in both institutions and how they accomplish SDGs 3, 10, and 11. This guide covers 5 main concepts, which all tangentially deal with the relationship of these activities with the 3 aforementioned SDGs. These 5 concepts were the profile of respondents and general activity characteristics, actions before and during the activity, and in the aftermath of it. The interviews were conducted with groups in both institutions, and all the professionals were directly involved in the planning and execution of the activities. The interviews lasted about 20 min in the case of The Museum of The Railway Museum of Catalonia and were closer to 55 min in the case of La Pedrera—Casa Milà. The difference is due to the number of people in the group in each case and to the fact that we were concerned that respondents should have the flexibility to express themselves freely in their answers [51].

In the case of The Museum of The Railway Museum of Catalonia, we interviewed the two people responsible for planning and conducting cultural activities for people with CI—the head of communication and education and the education technician.

At La Pedrera—Casa Milà, four professionals were interviewed, all of whom are involved in the implementation and coordination of these cultural activities for people with CI and are more closely involved with the REMS program. The four were: the head of the Dignified Aging team; one of the professionals in the team who has been collaborating for years with the cognitive accessibility script to adapt all the temporary exhibitions; a professional from the health memory stimulation reinforcement program which works with other professionals to adapt the visit of the temporary exhibitions and now also the visit of the building of La Pedrera—Casa Milà itself; and the head of exhibitions of La Pedrera—Casa Milà.

Direct non-participant observation [49] allowed us to analyze first-hand how cultural activities are developed and executed in both cultural institutions. An observation guide was designed beforehand to enable the correct analysis. The guide aimed to focus attention on the attitudes to be observed and all the relevant information to record. It considers the different stages a cultural activity may have and includes observable indicators related to the main concepts of SDGs 3, 10, and 11.

In this way, the observation guide is divided into three stages: the welcome, the activity, and wrapping up. The objective during these three stages is to observe aspects associated with the promotion of the well-being of the participants, situations that show the reduction of inequalities between this specific public and a more general one, and all aspects that may promote accessibility and inclusion.

Finally, analysis of official documents and the websites of both institutions was considered imperative to complete the data collection.

3.3. Data Processing

Collected data were analyzed by themes. NVIVO (Version 14) software was used to organize all the data from interviews, observations, and reviews of official documents better.

Indicators were established and identified in line with the research question: How do the characteristics of an institution affect the management, organization, and execution of cultural activities for people with cognitive impairment in their aim to achieve SDGs?

(a)

Promotion of well-being in people with CI through cultural activities.

(b)

All audience groups must have equal access to heritage.

(c)

Planning and execution of cultural activities ought to be based on the principle of inclusion.

3.4. Case Studies

3.4.1. La Pedrera—Casa Milà owned by Catalunya La Pedrera Foundation

La Pedrera—Casa Milà, located in Passeig de Gràcia in the center of Barcelona, was declared a Cultural World Heritage building by UNESCO in 1984. It is one of seven properties built by the architect Antoni Gaudí, now considered Cultural World Heritage, representing his work and the modernist movement [52].

Gaudí was commissioned by Pere Milà and Roser Segimon to design and build their family home. The main floor would be their apartment, and the rest of the premises would be rented out. The construction of the building, which was carried out between 1906 and 1912, was fraught with problems and controversy, going over budget and not abiding by building rules. In fact, it was called “La Pedrera” (stone quarry in Catalan) because of its resemblance to an open quarry [53].

Presently, La Pedrera—Casa Milà incorporates five different uses. It is a tourist site open to the public. In its cultural and social usage, there are exhibitions and activities. There are still residential apartments for rent. Commercial space for company offices and shops is for hire. Finally, for administrative use, it acts as the headquarters of the Catalunya La Pedrera Foundation [54].

In fact, the REMS program and the cultural activities in this study depend on the Catalunya La Pedrera Foundation. This foundation is the owner of La Pedrera—Casa Milà, and its objective is to improve the quality of life of people from different groups and manage social and cultural projects, including those in La Pedrera—Casa Milà [55].

It is important to mention that this foundation is a private non-profit organization, and the income comes from La Pedrera tickets and the co-payment of some of the programs they develop. The main objective is to ensure the maintenance of its social work thanks to the generated resources [56].

In the 2022 report of the foundation, a total of 849 people were directly and indirectly employed by this foundation, with 65 directly employed in the foundation, 264 in the Social Spaces where REMS program users go, and 40 in services directly related to La Pedrera—Casa Milà [57].

La Pedrera—Casa Milà is currently one of the most visited tourist sites and cultural facilities in Barcelona, with an average of 3000 visits per day [54,58]. There have been over 20 million visitors since it opened to the public in 1996. Presently, 4500 square meters of the building are open to the public and can be visited [54].

3.4.2. The Railway Museum of Catalonia

Built in 1990 in the coastal town of Vilanova i la Geltrú, The Railway Museum of Catalonia is situated at the original facilities of the steam locomotive depot in the town, which stopped operating in 1967. The facilities were in use from the end of the 19th century to the middle of the 20th century, attracting professionals from the railway sector from all over the country and having an impact on the contemporary history of this town. This is reflected in the character of the museum [59].

This museum emerged from the XIX Congress of European Railway Modelers (MOROP) held in 1972 in the same location where the museum is today. For this congress, RENFE (Spain’s national state-owned railway company) decided to transfer certain vehicles from all over the Iberian Peninsula to that former depot. Once the congress was over, the vehicles remained there, thus initiating future museums [59].

It has almost always been managed by the Spanish Railways Foundation, which is a public cultural organism that ensures the preservation, recovery, transmission, and dissemination of the historical heritage of the Spanish railway [59].

The wonderful collection of historical vehicles in the museum at a premises of 17,000 m² makes it an idyllic space to learn and discover the history of trains in Spain. It is important to note that the size of the premises is necessary for the dimensions of the objects that make up its collection, ranging from locomotives to wagons or passenger trains from different periods.

There was a total of 36,500 visitors in 2022, recovering pre-pandemic numbers, with an average of about 100 visitors a day [60].

Presently, the museum has seven in-house professionals, while cleaning, maintenance, and customer service are outsourced to two external companies [59].

3.5. Sample

Two group interviews were requested and carried out in mid-2023 with professionals involved in activities aimed at people with CI from La Pedrera—Casa Milà and with professionals from The Railway Museum of Catalonia. See

Table 1. Interviewed people.

Interviewed Person	Age Range	Gender	Museum
F1	60–70	Fem.	The Railway Museum of Catalonia
F2	50–60	Fem.	The Railway Museum of Catalonia
P1	50–60	Fem.	La Pedrera—Casa Milà
P2	30–40	Fem.	La Pedrera—Casa Milà
P3	50–60	Fem.	La Pedrera—Casa Milà
P4	40–50	Fem.	La Pedrera—Casa Milà

.

3.6. Ethical Considerations

The Bioethics Commission of the University of Barcelona reviewed and gave its approval to this research. Great care was taken to obtain permission from the cognitively impaired participants involved. A protocol was followed, considering their vulnerability, where participants with sufficient competence signed their own consent forms. Otherwise, this was subject to the approval and signature of a third party, normally their legal guardian, who must not be in a position of conflict of interest nor be a member of the research team. However, in this case, all participants were competent enough to provide informed consent and independently sign their consent form.

4. Results

Analysis of the collected data from both The Railway Museum of Catalonia and La Pedrera—Casa Milà allows us to understand and describe how these two institutions manage and perform cultural activities aimed at CI people and how these activities aim to achieve SDGs 3, 10, and 11, related to social inclusion, equality, and well-being.

It is important to consider that both institutions collaborate with the REMS program, and therefore, the promotion of well-being among the group to which these activities are directed is almost imperative. In both cases, there is also an effort to promote inclusion and reduce inequality; however, it is important to observe how the characteristics of each institution affect the achievement of these SGDs.

4.1. La Pedrera—Casa Milà

The results from the data collection relating to the interviews were analyzed. In Figure 4, we can see that, in that case, the predominant words during this interview refer to the activities themselves and the characteristics of their participants, as well as the conditions that these must meet to adapt to the target audience. The hierarchy of words in Figure 4 shows that the professionals display an extensive knowledge of the topic and a clear awareness of the activities themselves, which makes them ideal candidates for data collection and subsequent analysis.

4.1.1. The Promotion of Well-Being in People with CI through Cultural Activities

One of the professionals in charge of the exhibitions that took place at La Pedrera—Casa Milà stressed the importance of ensuring that people with CI could experience their cultural activity and obtain well-being from these experiences. This means putting aside the objectives that are normally expected when other audiences visit these types of exhibitions. Therefore, it proves that the promotion of well-being in this audience group through cultural activities is a significant aspect of its ideation and approach:

In the end, the goal is not about transmitting in-depth knowledge, especially in the group of Dignified Aging. It is more like this is a way to be able to socialize, to do this work that they do of cognitive stimulation, of reminiscing […] (P4, 2023).

Another professional, in this case, P1, who is more directly linked to the REMS program, emphasizes the benefits of these particular activities and, in general, visiting “social spaces” in terms of socialization for people with CI. They can come to enjoy a cultural aspect in their life, something that may have been missing prior to the diagnosis of their condition. Taking part in these activities and having a social life can also help them feel that they are still capable. It is important to mention that mainly the groups that carry out these cultural activities for people with CI from these “social spaces” are run by the Catalunya La Pedrera Foundation:

[…] Above all, I think that, from what I could tell, people who start to have cognitive impairment, in many cases, are not fully aware (of it) and therefore tend to isolate themselves a bit. And the fact that they are already starting at a center that is a social space means that they are starting to socialize a little more. But doing these activities is very important, because for them it is seeing that they can continue to do things. Some may not have had access to culture in their life until now, but they are discovering things and are interested—obviously not everyone, and others are rediscovering it […] (P1, 2023).

Another of their colleagues also points out how these activities show the institution’s will to contribute to the achievement of the SDGs related to well-being and inclusion, P2 (2023): “As an institution, the SDGs have to do with well-being and inclusion, which we are guaranteeing with these activities […]”.

The commitment of this institution, whether understood as the Catalunya—La Pedrera Foundation or as La Pedrera—Casa Milà, to promote well-being among people living with CI when they participate in their cultural activities is also evident during the practice of its cultural initiatives.

During the cultural activity that took place in the temporary exhibition of La Pedrera—Casa Milà, the groups were always accompanied by their support worker—usually a trained psychologist. This person knows all of them well and makes them feel “like family”. They had the script that had been pre-prepared by the museum to adapt the visit to this type of audience and had been instructed, in some way, to carry it out. The support worker conducted the visit according to the interests of the people who made up the group. It can be reassuring to have the same person with them on a daily basis to accompany them on the visit to the “social space”—a break from the routine.

4.1.2. Reduction of Inequality in Access to Culture for People with CI

One of the main objectives proposed by La Pedrera—Casa when carrying out cultural activities aimed at people with CI is undoubtedly to contribute to reducing the existing inequalities between this specific audience and what can be understood as the general public.

Regarding this aspect and focusing particularly on equitable access to resources, one of the professionals emphasized the institution’s commitment in this regard by the fact that although it often involves a significant amount of work in terms of creativity and reflection, the engagement of the team and its diversity enable them to always make it possible:

It works out well, because people get involved a lot, but also coming from very different angles. In the end, the enthusiasm of the project makes it unmatched. […] Precisely this diversity is what gives it grace, and it happens here because it can happen here, because it is a very special project. (P4, 2023).

It is important to mention that at the time of the interview, cultural activities for people with CI were only carried out in temporary exhibitions, which meant rethinking the set-up several times per year.

Another example of the institution’s will to reduce the inequalities of this collective is reflected in the efforts to personalize or adapt the activities to the needs of each specific group. For example, using headphones if many people in the group have hearing difficulties:

Yes, a few years ago we already saw that it made it a lot easier, and we incorporated it into the tours, the guide talks into the microphone, and the group use headphones and adjust the volume accordingly. And this helps people who have a hearing deficit to be able to hear much better. (P2, 2023).

During the interview, other professionals reflected on adapting the activities and resources to the specific needs that different collectives may have and on the fact of raising awareness or setting an example for the general public:

[…] because, regarding all these pieces, which all come from the artist’s house, we have reached an agreement with him. This audience group will put on some special plastic socks, and some plastic gloves, and then they can touch the pieces—well, some pieces. This makes this exhibition like a heavenly experience […]. (P4, 2023).

The same professional also emphasized:

But it’s something very specific, because, of course, the general public can’t touch them because they’re not meant to be touched. But of course, the public can only access these pieces through touch, so we’re trying to fix that. […] It’s nice that people see what goes on and how these groups are taken care of, and that there are people who have restrictions but they are given special treatment. (P4, 2023).

In practice, the will of all the professionals in this program to reduce inequalities in the access and enjoyment of culture by people with CI is evident. For example, upon arrival, they were offered the opportunity to walk up some splendid modernist stairs to the exhibition or take the elevator. The accompanying support worker also assessed and, if deemed necessary, asked the members of the group if they wished to use headphones.

However, as it is such a large institution with so many visitors and staff, not all staff members are aware of which specific audience group is visiting. This lack of awareness can sometimes result in confusion for both parties, visitors and staff. For instance, this fact became evident when a member of the staff who was watching over the exhibition room reprimanded the whole group for talking or when a clearly disorientated participant attempted to return the headphones to a different staff member, and this person seemed perplexed, not understanding why the visitor did not return the headphones to their designated location.

Despite the obvious challenges in managing the sheer volume of both staff and visitors, the dedication and efforts of the professionals involved in carrying out these activities with regard to inclusivity and accessibility for individuals with CI are excellent.

4.1.3. The Enhancement of the Inclusion of People with CI in the Cultural Field through Cultural Activities

In some ways, La Pedrera—Casa Milà and Catalunya La Pedrera Foundation are intricately linked, and this is evident when considering inclusion issues.

To ensure that the people with CI visit what the foundation calls Social Spaces and feel like active participants in these activities, they agree on appropriate cultural activities. This is a positive way to make them active participants in the experience, as one of the professionals mainly working for the REMS program explained:

A meeting is held, and activities are proposed. We discuss if we should highly recommend them, whether we insist that they are really worth it and try to encourage them to come. But in reality, it’s up to them to decide if they come or not. (P1, 2023).

Furthermore, all the participants who come from the Social Spaces network to visit La Pedrera—Casa Milà are accompanied by their regular support workers. As they know them well, they can decide on appropriate adaptations to the generic script to suit the group or the individual. This allows them in some way to feel more protagonist, P1 (2023): “[…] the professional tries to include everyone in the questions, mainly because they know them and their interests and life story”.

In practice, we see that La Pedrera—Casa Milà is an institution that is fully committed to inclusion. However, if the visiting group does not come from its Social Spaces network, it may affect the success of the inclusion. It is important to mention that cultural activities for people with CI are carried out during exhibition opening times for the general public. This may present some drawbacks, but it can also be very positive for the participants, who can feel like and regard themselves as just another visitor, treated equally, and share space and time with the general public.

4.2. The Railway Museum of Catalonia

The results from the data collection related to this interview were also analyzed. In Figure 5, we can see how the predominant words are those that can be easily related to what can be understood as keywords to describe the experience themselves. Nevertheless, words directly related to the characteristics of their participants and their needs were also mentioned during the interview but with fewer repetitions. In that case, the hierarchy of the used words shows the knowledge of the professionals about the theme as well as their awareness about this kind of activity and the participants taking part in it.

4.2.1. The Promotion of Well-Being in People with CI through Cultural Activities

The discourse of the professionals who take responsibility for the management and execution of cultural activities aimed at people with CI denotes a great conviction for the well-being that culture can bring to different collectives.

They are aware of the potential of museums and culture in general, as well as the current needs of society. Therefore, they promote well-being from their institution and through their cultural activities:

[…] But we also now have this more social task which is to attend to the needs or the functional diversity that we as a society also have, and that is reflected in this social project. Promote people’s well-being. Encourage a healthy culture. We have all now realized it scientifically, after the pandemic, but we museums already had it clear before. But since the pandemic it has been scientifically proven that somehow culture can heal people. (F1, 2023).

Professionals agree that the promotion and achievement of well-being for participants with CI in the activities they offer are evident but are unable to provide scientific data to support the idea:

Yes, we are sure that well-being is promoted because during our visits there, as well as the ones they do here, we can feel it, we see it. The thing is, we don’t have scientific data that can prove it, but we see how the experience brings out these memories. We can almost see in their eyes how the thread of memory is formed. (F1, 2023).

During these activities, it was also evident how sensitized professionals are in this institution. They know their audience well and try to provide them with emotional well-being by presenting apparently simple activities, but which are actually quite complex. For example, at the end of each activity, they play a well-known Spanish song about trains that became popular precisely during the adolescence of most of the audience. At this moment, the happiness expressed in their gestures and actions is very evident. Another example of involving the participants is providing objects that they can touch. There were some photographs that were extremely fragile, but museum professionals believed that they had to be part of the activity, so they made copies that the participants could have in their hands to look at with care and attention.

4.2.2. Reduction of Inequality in Access to Culture for People with CI

Both in the statements that the professionals of The Railway Museum of Catalonia made in the interviews and during the observations of the practice of the cultural activities they offer to people with CI, it is evident how much they value the importance of reducing inequality in access to culture between this group of people and the general public.

At the institution, they appreciate that access to culture for people with CI can, at times, be more complicated, or perhaps the habit can even be lost when they receive the diagnosis. Thus, to facilitate access to their institution from the museum, all the people who participate in these activities are given complimentary tickets to visit the museum again, with their family or with whomever they wish, but without having to participate in any specific activity.

[…] we offer them some advantages. We give them tickets to visit the museum with family members who can accompany them whenever they want. So, they can visit the museum not only at the time when they are doing these activities, for example, like the one we offered today. In other words, they can come at any other time to visit the museum. (F1, 2023).

Another important point that one of the professionals highlighted is the fact that the institution staff remain available for the professionals who are with the participants in the Social Spaces or other types of care centers to adequately prepare for the visit to the museum and the activity in their center. That means, in some way, adapting the activities to the particular needs of each group, F1 (2023): “At first, we provide them with material, and we remain at their disposal. That means providing to the professionals who are usually taking care of them what they need to do it as best as possible”.

The treatment that participants receive from museum professionals during the activities shows the importance they give to personalized treatment, one of the main elements that characterizes the reduction of inequalities in terms of access to culture [61,62]. This personalization is apparent from the moment the museum professionals ask the support workers of the participants to put a name tag on each of them so they can address them by their names. Again, it is a simple gesture, but one that undoubtedly improves the experience.

4.2.3. The Enhancement of the Inclusion of People with CI in the Cultural Field through Cultural Activities

In the interviews, it became clear how museum professionals appreciated that participants should be involved and feel integrated into the activities. They also showed awareness of the need to use resources to promote an environment where participants with CI felt treated the same as regular visitors and that they were not receiving any special treatment as part of a social project.

The museum professionals stressed the importance of making participants feel that they are being treated as the rest of the visitors and the tools they use to achieve this F2 (2023): “They are treated absolutely normally. I mean, we are always choosing words very carefully, what we say, trying not to offend, but also not pointing out that they have…”

In other words, they do not notice that it is a special activity or that they are special and should be treated differently. No. They are the same as other visitors to the museum. And then, I especially like to make them participate, so that they see they are participants of the project just like we are. […] Exactly, that they are protagonists too, not just the professionals who are attending to them, not the people who are in the museum, no, they are the ones who are also involved, just like everyone else. (F1, 2023).

During these activities, it became clear that participants really had the perception of being involved. The museum’s commitment to promoting this was also evident, for example, when a group of participants displayed their own “exhibition” of drawings of trains during the museum visit. This undoubtedly made the participants feel proud and proved the value of the project because that “exhibition” remained there in the museum to be admired by all visitors. Another example was when, in the second session, one of the participants gave one of the museum professionals a photo of herself as a young woman in which she appeared with a train. In that way, she was literally contributing to the museum collection.

4.3. Comparing La Pedrera—Casa Milà with the Railway Museum of Catalonia

Table 2. Comparative table. La Pedrera—Casa Milà compared to The Railway Museum of Catalonia in terms of activities aimed at CI people.

Theoretical Approach SDGs 3—Promotion of Well-Being
	La Pedrera—Casa Milà	The Railway Museum of Catalonia
Promote conversation and socialization among participants [31].	Yes	Yes
Small groups, person-centered approach [31,61,63,64,65,66,67,68,69,70,71].	Sometimes	No
Find a low audience time or an institution closed to the general public to conduct the activity [65].	No	Yes
Free activity [65].	Yes	Yes
Ensure the promotion of the program or activity among interested people [65].	Yes	Yes
Evaluate the benefits the participants obtained through the program or activity [31,64,65].	Yes	No
Theoretical Approach SDGs 10—Reduction of Inequalities
	La Pedrera—Casa Milà	The Railway Museum of Catalonia
Develop specific programs or activities for different audiences [72].	Yes	Yes
Ensure physical and sensory accessibility [31,64,73,74].	Sometimes	Yes
Collaboration between knowledge disciplines [75,76].	Yes	Yes
Train and sensitize staff and professionals [64,77].	Sometimes	Yes
Raise awareness and educate society by setting an example [64,78].	Yes	Yes
Practical Approach SDGs 11—Inclusive and Accessible Spaces, in Particular for Older People and People with Disabilities
	La Pedrera—Casa Milà	The Railway Museum of Catalonia
Itinerary with coherence among the included works, that includes works, authors or themes that are known to the audience and adapted to audience needs and objectives [31,77,79].	Sometimes	Yes
Promotion of active participation of participants [9,80].	Yes	Yes
Provide an environment where all groups are treated as the rest of visitors and with respect [9,81].	Yes	Yes
Participants must feel like protagonists and not just recipients of the experience [9].	Sometimes	Yes

is a comparative table that illustrates how each of the selected SDGs is approached at a theoretical and practical level by each of the cultural institutions.

4.3.1. Practical Approach SDGs 3—Promotion of Well-Being

• La Pedrera—Casa Milà

In the script the museum provides, there are questions about the works that the professional accompanying the group of participants must ask in a general way to promote dialogue and interaction between them.

The groups are accompanied by their regular professional support workers. The size of the group depends on how many participants sign up for a visit, and visits are carried out during opening times.

Groups are previously given material to be able to prepare for the visit, and later they are also provided with cognitive and creative-expressive stimulation material.

The activity is free for the participants and is promoted directly in its Social Spaces network, and other centers that may be interested are contacted directly.

The program as a whole and each individual activity is normally evaluated.

• The Railway Museum of Catalonia

Participants, their support workers, and museum staff are encouraged to engage in conversation and share personal experiences about trains.

All the Social Spaces network users participated, and group sizes were large, but an adequate number of professionals accompanied them, with the ratio of participants per professional being 5–6:1. Furthermore, for each museum visit, participants were divided into 4 more manageable groups.

The full experience includes an activity at the care center before the visit to the museum during regular opening hours—the museum is usually not very crowded. The activity was free of charge for the participants, and free tickets were handed out at the end to encourage a return visit.

Social networks and other communication channels are used to share their work.

An explicit evaluation of these activities is not conducted.

4.3.2. Practical Approach SDGs 10—Reduction of Inequalities

• La Pedrera—Casa Milà

They offer activities and programs for people with CI and other groups with specific needs. An elevator can be used to access the temporary exhibitions, and headphones will be provided to participants with specific hearing needs. Museum professionals work to expand their resources to make the exhibition accessible to all audiences. However, there are certain limitations due to La Pedrera—Casa Milà being a World Heritage building.

Museum and foundation professionals come from different backgrounds and fields of expertise, which enables them to work together as an interdisciplinary team on the creation of programs and activities with diverse visions.

One of the foundation’s missions is to raise awareness of causes and carry out activities for the general public in a heritage building like La Pedrera—Casa Milà, which is a great showcase for any cause.

• The Railway Museum of Catalonia

They offer activities for a variety of groups, including people with CI. An accessibility and inclusion plan received a subsidy. The museum facilities are accessible to people with reduced mobility. There are easy-to-read text panels (aimed at children), braille text, and tactile signage.

The activities are designed and carried out by museum professionals. However, support workers are always present and assisting when needed. Participants can also be accompanied by family members.

During the activities, participants are encouraged to produce works that will be exhibited in the museum or through a repository on the museum’s website.

4.3.3. Theoretical Approach SDGS 11—Inclusive and Accessible Spaces, in Particular for Older People and People with Disabilities

• La Pedrera—Casa Milà

As a World Heritage building, possible improvements for motor/mobility accessibility can be restricted. However, there is an elevator, and resources are designed to make the exhibitions accessible to all groups.

The temporary exhibitions take place in La Pedrera—Casa Milà, which is itself a well-known modernist building by the architect Antoni Gaudí.

Participants are encouraged to express their own opinions and share their experiences during the activity. Participants feel like they are in a safe environment because their regular support workers are in charge of carrying out the activity.

• The Railway Museum of Catalonia

There are facilities for accessibility, and an inclusion plan is in place for the resources and the activities. The “trains” theme of the museum is well-known to the participants, and it has usually played a role in their lives. Because of this, the activities are cohesive and coherent.

Participants actively collaborate in preparing the activities, and their work will be displayed in the museum. Museum professionals make a huge effort so that participants feel like they are part of the project and not just recipients of it.

5. Discussion

This study suggests that certain characteristics of cultural institutions can influence the management and execution of cultural activities for people with CI. Results from the compared institutions show that professionals involved in the project seek to promote social inclusion, equality, and well-being through cultural activities aimed at people with CI.

La Pedrera—Casa Milà has an impressive multidisciplinary team working for the heritage institution and linked to the Catalunya—La Pedrera Foundation. The team is made up of professionals from different backgrounds, including clinical psychologists, cultural management professionals, and art historians, among others. Such a combination of professionals working together means that activities are designed to encourage audience participation in the temporary exhibitions. They are also working on launching new activities directly related to the La Pedrera—Casa Milà visits.

The REMS program professionals strive to develop these activities as suitably and conscientiously as possible. It is important to note that the foundation that promotes these activities for people with CI, of which La Pedrera—Casa Milà is the headquarters, has very substantial human and financial resources that are the envy of other less prestigious institutions.

One of the issues an institution this large may face is the fact that not all workers are connected to the REMS program or the activities themselves, so it is possible that the participants’ well-being cannot be ensured at all times since certain workers would have had little to no training in the matter. Additionally, security staff and museum attendants may be unaware of the specifics of the activities and could reprimand behavior that they perceive as inappropriate. These issues are likely to be the result of a lack of communication between departments and staff because of the large size of the institution, and the professionals that work there do not always have sufficient training on how to attend to special needs audiences or an adequate background [82].

The scripts used for the activities are carefully worded and of excellent quality. However, some expert knowledge may be missing during the visit because the support workers accompany the participants to provide a safe environment, which is of utmost importance for this group [83]. Perhaps a solution could be to have two professionals working together during the activities, something that the institution professionals indicate is usually done.

The professional team and resources available to the Catalunya—La Pedrera Foundation, and consequently to La Pedrera—Casa Milà, clearly make an ideal pairing to coordinate different cultural institutions that can carry out cultural activities catered to the users of their social spaces. This is a challenging task, and only institutions with the characteristics of La Pedrera—Casa Milà can effectively execute it [84].

However, while La Pedrera—Casa Milà has an extensive multidisciplinary team, The Railway Museum of Catalonia benefits from a small but wholly committed team [23,24,85].

For example, there was an excellent level of coordination among the staff members [85], and the sensitivity in their treatment of the participants of the activity is praiseworthy. Also, because the institution receives fewer visitors than La Pedrera—Casa Milà, the participants were practically alone during the activity. Although the institution has an accessibility plan for the building, there was an aspect that had been overlooked and devalued the experience; in the museum, there is a hangar with train cars and machines that introduced and concluded the activity, but because there is no air conditioning it becomes extremely hot, which can be dangerous for an elderly audience member that has dementia [86]. It is likely that high temperatures were not such a concern in the past, but it is likely to become an increasingly important element to consider due to climate change.

Despite not having specialists in all areas, museum professionals execute activities exceeding expectations. It is common for smaller cultural institutions to be multidisciplinary, with professionals taking on various roles [82,84,87]. Activities are conducted by museum professionals, and participants are accompanied by their regular support workers. The exceptional sensitivity, training, and judgment of museum professionals are noteworthy in executing the activities. Moreover, information about the content is provided by the museum professionals, enhancing the activities and allowing for improvisation and adaptation according to the audience’s curiosities, questions, and interactions.

The Railway Museum of Catalonia’s proximity to its community and local character make it an ideal institution for meeting the needs of its participants [23,24,87,88]. Additionally, activities are more manageable because of the size of the museum. Unfortunately, evaluating such programs is often impossible due to a lack of time, planification, and resources. However, the REMS program of the Fundació Catalunya—La Pedrera attempts to address this issue by providing a comprehensive evaluation of the program. The theme of the museum as a railway museum is particularly suitable because it relates to daily life and has played a role in participants’ lives. As a result, it enables them to remember, explain, and actively participate, becoming protagonists in the activities.

By comparing both institutions, it becomes apparent that their distinctive traits have an impact on the strategy and execution of cultural initiatives designed for individuals with CI, consequently influencing the achievement of SDGs that pertain to them [89]. Therefore, it is imperative to establish specific objectives for each institution. Moreover, instead of merely highlighting the differences between the two institutions, it is better to contemplate how cooperation between them can bring advantages, not only for the institutions themselves but also for the individuals involved. Together, they can accomplish more than they could apart. It is clear that when a prominent and esteemed institution collaborates with a smaller, more community-focused one, it can significantly enhance cultural involvement by extending its reach to a wider audience. In this way, both entities stand to gain by forging new connections, acquiring fresh expertise, and reaching a wider audience [84,90].

There are clear differences between these two institutions, most noticeable in financial resources, number of visitors, number of employees, and their profiles. However, these differences can complement one another. La Pedrera—Casa Milà, serving as the headquarters for the Catalunya—La Pedrera Foundation and the managing entity for the REMS program, brings expertise and resources associated with a large team with significant financial backing. Meanwhile, The Railway Museum of Catalonia offers proximity and opportunities for closer community connections, promoting a more personal and authentic experience. Moreover, the activities offered by this museum may be more positively received than those which are more market-oriented or commercially driven [84].

The United Nations has recommended that governments and large organizations are accountable for achieving the Sustainable Development Goals and implementing them locally. This research has found evidence that SDGs are being implemented and achieved in both case studies: La Pedrera—Casa Milà, leading the REMS program, and The Railway Museum of Catalonia, a smaller institution focusing on community-centered activities for individuals with CI [23,24,85,91,92,93]. In both cases, the well-being of participants is enhanced, and social inclusion and equality are improved.

Cultural activities aimed at people with CI, as demonstrated by different studies, offer different benefits to participants: above all, cognitive stimulation, improved well-being and mood, and promotion of socialization [10,11].

It is important to note that these benefits are related to the management and execution of the activities themselves [94,95,96], which will undoubtedly depend on the characteristics of the institution that carries them out [97], as has been seen in this study.

However, although various studies can be cited where the activities were carried out in renowned institutions such as the MoMA or El Prado [28,98] or in institutions with great capacity and resources such as the National Museum of Liverpool [99], among others [47], it is important to emphasize the notable scarcity of research of this nature focused on small local institutions. This study, in addition to showing that the characteristics of institutions affect the benefits they can provide, also highlights the crucial role that small institutions play in their community [24,85,93], contrasting it with the benefits of large institutions.

Thus, in this research, it is demonstrated once again that collaboration between large and small institutions has proven to be beneficial both for the entities involved and for the general public. This finding, far from being novel, reinforces the conclusions of other studies related to how collaboration between small and large institutions is beneficial [23,84,91]. However, this case focuses on the specific case of carrying out cultural activities for people with CI and how this collaboration expands the scope and has a positive impact on people with CI in terms of well-being, inclusion, and equity.

Therefore, to effectively plan cultural activities for individuals with CI, it is crucial to consider the characteristics of cultural institutions. Objectives should align with SDGs, specifically those targeting the promotion of social inclusion, equality, and well-being. Despite evident differences, collaborations between larger and smaller institutions can be mutually beneficial and have proven to be effective. Both institutions can complement each other by leveraging their strengths to successfully promote social inclusion, equality, and the well-being of participants.

This study has certain limitations which must be taken into consideration.

First, this research is based on a comparative case study of only two institutions. A characteristic limitation of the case study methodology is the impossibility of generalizing the results. However, being a comparative case study allows for analytical generalization, i.e., the generalization and expansion of theories [100].

A further limitation is the fact that all the people interviewed are women. However, it is important to note that it is circumstantial, given that the choice of study cases was carried out taking into consideration their characteristics, not the gender of the people who work in it.

In future research, it is suggested that further exploration of how the different profiles of professionals and their training affect the experience and benefits that participants with cognitive impairment obtain from cultural activities is suggested. Likewise, it will be interesting to determine the best way to evaluate cultural programs and activities aimed at people with CI.

6. Conclusions

The main aim of this study was to know how cultural institution characteristics can influence the management and execution of cultural activities aimed at people with CI. To achieve the objective of this investigation, a comparison between two contrasting institutions was performed, concluding in several key findings, which are presented below.

Institution characteristics matter: the size, prestige, resources, and formation of the team of cultural institutions can have a significant impact on the design and how the activities aimed at people with CI are performed [23]. La Pedrera—Casa Milà, a large institution that is well-known and prestigious and has a large multidisciplinary team with substantial resources, stands out for the design of its activities and the evaluation that is carried out. In contrast, The Railway Museum of Catalonia, being an institution with a local character and a small but wholly committed team, performs activities that are more personalized, and due to its subject matter, it can offer more relatable experiences.

Collaboration is key: institution type has proved to achieve positive outcomes related to the referred activities. Nevertheless, collaboration between them can offer even greater benefits. Prestigious and large institutions such as La Pedrera—Casa Milà can contribute with their resources and expertise, while a community-focused institution such as The Railway Museum of Catalonia can provide unique and closer connections. For these reasons, together, they can bring a more beneficial and enriched experience to the participants, and they can also learn from each other and mutually benefit.

SDGs contribution: this study shows that cultural institutions aimed at cognitively impaired people can contribute to enhancing well-being, equity, and inclusion, contributing to the achievement of the SDGs goals. Both institutions have proven to bring positive impacts in these areas. However, to really contribute, it is important that institutions align the objectives of the activities with the aforementioned aspects without losing sight of their characteristics, possibilities, and real needs of the target audience.

In conclusion, the characteristics of cultural institutions can play an important role when taking into consideration social inclusion, equity, and well-being of people living with CI. Identifying what characterizes each institution and encouraging collaboration between different institution types can enhance the impact and benefits of these cultural activities. The findings of this investigation support the raised hypothesis, revealing a significant relation between characteristics of cultural institutions, how they manage and develop cultural activities aimed at CI people, and how it affects the well-being they provide to the participants, as well as their degree of equity and inclusion.