DOWNLOAD THE DIVA+ FOR FREE!
HOW TO CITE: Cottrell K, Martin B. DIVA+ Performer Health Assessment Framework. 2nd ed. Performing Arts Medicine Association; 2026.
MEET THE DIVA+
The framework takes its name from the four core performing arts disciplines it was originally designed to serve — and the + reflects its ever-expanding reach.
DANCERS
Ballet, contemporary, commercial, folk, and all dance disciplines.
INSTRUMENTALISTS
Orchestral, chamber, solo, jazz, popular, and all instrumental musicians.
VOCALISTS
Classical, contemporary commercial, folk, and all singers.
ACTORS
Theatre, screen, physical theatre, voice, and all acting disciplines.
AND BEYOND
Circus, musical theatre, interdisciplinary, and emerging performance practices.
A FRAMEWORK BUILT AROUND THE PERFORMER
The DIVA+ is a comprehensive, consensus-based clinical tool designed to support the health assessment of performing artists across disciplines. It provides a structured, modular approach to identifying risk factors for injury, illness, and performance-related health concerns.
It assists with early recognition of health- and performance-related issues, and supports clinical decision-making, referral, and follow-up where indicated. The DIVA+ is a health assessment framework — not a diagnostic or clearance instrument.
Positive findings within any section indicate the need for further, discipline-specific evaluation by appropriately qualified health professionals.
THE DELPHI CONSENSUS PROCESS
The Second Edition of the DIVA+ was revised through a comprehensive international Delphi consensus process led by Dr. Kat Cottrell with support from Dr. Brendan P. Martin. Three rounds of structured qualitative and quantitative feedback were used to evaluate clinical relevance, inclusivity, trauma-informed practice, and feasibility.
Twenty-five international performing arts medicine experts — spanning medicine, allied health, psychology, education, research, and more — came together to shape this Second Edition.
KEY PRINCIPLES FOR USE
The DIVA+ was built on a set of principles that reflect the values of performing arts medicine and ethical clinical practice.
Modular & Flexible
Not all sections are for every performer. Select sections relevant to the performer's discipline, presenting concerns, and performance context.
Performer-Centered
Participation in any section is voluntary. Performers may skip questions or choose "prefer not to answer" at any point.
Trauma-Informed
Sensitive sections (including mental health, trauma, and substance use) should only be included when the assessor can respond appropriately.
Only Administer What You Can Act On
If a section raises concerns, the assessor must be able to provide guidance within their scope or refer to a clear pathway for follow-up.
Biopsychosocial
Concerns in one domain may be influenced by factors across others. The DIVA+ reflects the interconnected nature of performer health.
FRAMEWORK SECTIONS
The DIVA+ spans the full breadth of performer health — from the questionnaire completed by the performer to the clinical assessment conducted by the healthcare professional.
Demographic Information
Performance Related Activities
Musculoskeletal Symptoms & Function
Task-Specific Motor Control & Embouchure
Hearing Health & Sound Exposure
Voice, Breathing, Throat & Jaw Health
Health History
Menstrual & Reproductive Health
Physical Conditioning & Fitness
Nutritional Information
Psychological Wellbeing
Substance Use
Physical Health Assessment (Clinician)
Clinical Recommendations & Follow-Up
WANT TO USE THE DIVA+ IN CLINICAL PRACTICE?
The DIVA+ is freely available to everyone. However, the Essentials of Performing Arts Medicine Course provides the dedicated training to use it effectively. It covers the rationale behind every section, how to interpret findings, and how to apply the framework across disciplines and clinical contexts. Completion of EPAM is strongly recommended for clinicians intending to use the DIVA+ with patients.
The DIVA+ clinical walkthrough is included in both the Healthcare Professionals Stream and the Ultimate Essentials of Performing Arts Medicine.
DOWNLOAD THE DIVA+
HOW TO CITE: Cottrell K, Martin B. DIVA+ Performer Health Assessment Framework. 2nd ed. Performing Arts Medicine Association; 2026.
