Summary of the impact

This case study outlines the impacts arising from research conducted since 2001 by members of the UoA working in the Sidney De Haan Research Centre for Arts and Health (SDHRC), into the health and wellbeing benefits of group singing. The impacts have included improvements in the health and wellbeing of participants in specially created `singing for health' choirs, including clinically significant improvements in: mental health (mental health service users); lung function and health-related quality of life (Chronic Obstructive Pulmonary Disease COPD patients); and social, emotional and physical health benefits (older people). Additionally, an ongoing programme of research, dissemination and public engagement has acted to demonstrate and measure these benefits, promoting their potential for public health, and thus informing professional practice, public understanding and public policy.

Underpinning research

Following an exploratory study into singing and wellbeing (2001) by Co-Directors, SDHRC, Hancox, Professor of Music ( CCCU 1982 to retirement in 2012) and Prof Clift (Faculty of Health and Social Care, CCCU 1980 -), the SDHRC was founded in 2004 and has since then maintained a particular focus on research into the health and wellbeing benefits of group singing. A progressive programme of quantitative, mixed-methods and qualitative research has been developed with the support of substantial external research grants, building on the aims stated in the Unit's submission to RAE 2008. This programme has included:

• A large cross-national study of choral singing in Australia, England and Germany, involving over 1,000 people, indicating that psychological, social, spiritual and physical wellbeing can be positively affected by regular group singing (Hancox et al; 2010)
• Qualitative evaluation of singing groups established for older people without a history of regular singing, providing evidence of psychological and social benefits (Skingley, CCCU 2004 - present and Vella-Burrows (Assistant Director, SDHRC, CCCU 2003 - present); 2010)
• An RCT funded by the Research for Patient Benefit programme (NIHR) on the wellbeing and health benefits of group singing for older people, demonstrating a significant improvement for participants who sang on measures of mental wellbeing at the end of the intervention and on a further three-month follow up. Over 300 participants were involved, with half of those randomly assigned to weekly singing groups over three months, and the other half acting as usual activity control group. Vella-Burrows led on the practical delivery of the singing groups and facilitated the Ramsgate and Whitstable groups.
• A longitudinal study of group singing involving over 100 people with a history of enduring mental health problems, demonstrating a significant improvement in mental wellbeing using a validated clinical measure widely used in mental health services for screening and evaluation (Hancox, Vella-Burrows et al; 2011)
• A major longitudinal study examining the impact of singing on breathing among people with chronic obstructive pulmonary disease (COPD), supported by the Dunhill Medical Trust, demonstrating that measures of lung function and health-related quality of life significantly improved over the 10 months of the singing programme (Vella-Burrows, Shipton (Research and Knowledge Exchange Officer, SDHRC, CCCU 2010 - present) et al; 2013).
• Two systematic mappings of existing research on singing and wellbeing point towards specific benefits for people with long term conditions such as Parkinson's and COPD (Hancox et al 2007; 2008) and further research is in planning in these areas. A funded pilot study on the value of group singing for maintaining and improving voice quality for people with Parkinson's will provide the basis for developing further research on group singing as a form of speech therapy.

References to the research

Evidence of the quality of the research includes the rigorous peer-review processes attached to the above outputs, and the success of the SDHRC in winning external research funding. Charitable trust funding to support SDHRC projects investigating the health impacts of singing includes £600k (2004-10) from the Roger de Haan Charitable Trust, £300k (2011-14) from the Oak Foundation and £130k (2010-12) from the Dunhill Foundation. NHS and public funding provided to support research into singing and health includes £100k (2009-10), £250k (2010-11) and £140K (2013-14).

Details of the impact

The Unit's researchers, including Hancox, Vella-Burrows and Shipton, have sought to maximise the impact of their research through the creation, support and (in several instances) direction of a number of specific, health-related choirs. Through the implementation and ongoing refinement of the insights gained through their research, these choirs have led to substantive health and wellbeing benefits to individuals with long-term conditions, their families and communities, as well as further promoting and evidencing the health and wellbeing benefits of singing.

These choirs include Skylarks, a network of Singing for Parkinson's singing groups established in 2010 by Hancox in collaboration with local Parkinson's Society support groups. There are currently choirs in Canterbury, Folkestone and Whitfield, with over 80 people with Parkinson's and carers participating in a fortnightly programme of singing designed to help maintain and improve voice quality, and sense of wellbeing. The choirs have performed at two international conferences and were featured in a BBC breakfast news report. Data establishing the health and wellbeing impacts has been captured through reflective blogs, video media, and carers' testimony (eg "My Mum was diagnosed with Parkinson's eight years ago and suffers from acute anxiety, especially in public situations. To say the singing group was a triumph would be an ENORMOUS understatement. It was the first time she has felt comfortable enough to stay for an entire group event in a very long time. She was literally buzzing on the way home, as was I"). A protocol for a controlled research study has been designed and funding is being pursued. The East Kent Singing for Mental Health Network of singing groups was established in 2009 by Vella-Burrows and others in collaboration with Eastern and Coastal Kent PCT and Kent and Medway NHS and Social Care Partnership Trust to provide opportunities for singing and support for over 100 people with mental health needs. A clinically significant improvement in mental wellbeing was found using a validated clinical measure (CORE). Findings from the evaluation have shown statistically significant improvements, suggesting that regular group singing promotes wellbeing (Clift and Morrison 2011). Qualitative data from participants (and professionals' testimonies 5 and 6 below) point to marked improvements in mental wellbeing for people with a range of enduring mental health issues. The network has featured on BBC World Service (September 2011), and been awarded £140k further NHS funding to extend into West Kent and Medway.

The East Kent Singing and COPD Network of singing groups was established by Vella-Burrows and others for research purposes in September 2011 with funding from the Dunhill Medical Trust, and in collaboration with Eastern and Coastal Kent Community Health Trust and the British Lung Foundation. Over 100 people with COPD were recruited into the study and met weekly to participate in a programme of singing designed to promote better breathing. Six of the singing groups have continued, are self supporting, and attended by over 100 people following the end of the research phase. The research has demonstrated evidence of significant improvement in measures of lung function (FVC improved from 2430ml to 2540 ml over the ten months of the study) and health-related quality of life for participants in the singing groups, as well as social, psychological and physical health benefits from taking part. Testimonies from participants include "This group has been extremely helpful in many ways, physically and psychologically. I just don't have to worry about breathing any more. I am much calmer now and my sleep has improved" and "I go to the group with a tight chest, and leave feeling I can breathe again. The nurse measured my lung capacity: it improved through the singing classes!" Vella-Burrows has also created a number of Singing for Health clubs for people and family carers living with the effects of dementia, for example Seaview Singers, which was established in 2008 and still has approximately 30 participants. Partners of dementia patients have spoken of the profound impact these groups have on the patients' alertness, posture and ability to engage with others.

As a direct result of their engagement with the work of the Unit's researchers, a number of external organisations have themselves established singing groups in order to implement the outcomes of this research. Brighton and Hove PCT, for example, now provide singing groups for people with dementia as a direct consequence of research on singing and dementia conducted by Vella-Burrows and other SDHRC staff. Connors House care home established a partnership with the SDHRC in 2006 to provide inter-generational musical and singing activity for elderly residents, and to date over 150 residents and care staff have participated.

The independent charity Sing For Your Life was established in 2005 by Hancox and Vella-Burrows (and others) specifically to transfer the research findings of the SDHRC into practice. Sing For Your Life runs over 40 singing groups for older people across the South East of England and elsewhere in the country reaching over 1,000 older people in community and care settings every month. Singing groups have also been established in Canada, Finland and Italy following the same model, and building directly on the Unit's research. Qualitative evaluation, surveys and a pragmatic community based RCT funded by NIHR (the project ran in 2010-11 with findings published in 2012) have provided clear evidence of significant effects of regular group singing facilitated through Sing For Your Life on the mental wellbeing of older people. Sing For Your Life are now focusing on delivering singing in residential care settings, thus widening the reach and impact of the singing for health model (www.singforyourlife.org.uk).

The Unit's researchers have also sought to maximise the impact of their research into singing and health through disseminating their findings at conferences and seminars attended by practitioners and policy makers, thereby encouraging and supporting the adoption and application of their findings elsewhere. These include three international conferences organised by Shipton for SDHRC: Music and Health: Current Developments in Research and Practice (9-10/9/08; 110 delegates); SEMPRE Conference on Music Health and Wellbeing: 'Striking a Chord' (9-10/9/11; 125 delegates); SEMPRE Conference 'Setting the Tempo' : The need for a progressive research programme on Music Health and Wellbeing (19-20/4/13; 80 delegates). Practitioners from across the UK and beyond have taken up these interventions. For example, Pauline Waugh, a Lead Practice Nurse in Edinburgh writes: "I have been trying to emulate your success with your singing groups for patients with COPD [...] We now have both ethics approval and funding for our project called `Singing for COPD — Take a Breath' and we officially start this Monday (7^th Oct) [...] We are running a study similar to your original one in order to determine if this type of singing group could be rolled out across Edinburgh in the first instance".

The Unit's researchers have also made a particularly distinctive contribution to maximising the impact of their research through offering training to those interested in developing skills and careers in leading singing groups for those with long-term health conditions. Staff carers have been trained at Connors House (a residential care home), at six care homes run by Abbeyfield, Kent, and at others including Avanti Care Homes. Training has been provided to Kent County Council, both in schools and in older people's services. Partnerships have been formed with arts venues (e.g. Turner Contemporary), and support provided to other professionals (e.g. the Ladder to the Moon Theatre Company). The most significant output from the Unit's training work built around its research has been the publication in 2012 of four Singing for Health Guides, focusing on Dementia (Vella-Burrows), Mental Health (Clift, Morrison), Parkinson's (Hancox, Vella-Burrows) and COPD (Clift, Morrison), and an associated programme of training. To date, 80 health professionals and volunteers have attended these training days led by SDHRC since September 2012, making a substantial contribution to the development of a singing for health network. In addition, an International Journal for Arts and Health (published by Taylor and Francis) was launched in 2009 as a direct result of the work of the Sidney De Haan Research Centre.

Sources to corroborate the impact

1. Singing for Health Guides http://www.canterbury.ac.uk/Research/Centres/SDHR/ CentreNews/SingingforHealthGuides.aspx
2. BBC Breakfast feature on Parkinsons choir — first broadcast on 15^th November 2011
   http://www.bbc.co.uk/news/health-15732780 (Average audience 1.6 million)
3. BBC World Service Healthcheck programme Singing and Mental Health
   http://www.bbc.co.uk/programmes/p00k0jzy (Average audience 200,000)
4. Sing For your Life charity (Impact of research on older people). CEO (contact I.D. 1)
5. Eastern and Coastal Kent PCT (the impact of research for mental health service users) and older people (contact I.D. 2)
6. Kent and Medway Partnership Trust. Lead Occupational Therapist. (contact I.D. 3)
7. British Lung Foundation (the impact of the research on singing for people with chronic respiratory illness), National Services Manager. (contact I.D. 4)
8. Royal Society for Public Health (the impact of research on the Royal Society's practitioner training programme and on the public health practice development), Director of Development. (contact I.D. 5)
9. Kent and Medway Europe and Health Centre (the impact of research on singing and health on health professional's practice engaged in the Gruntvig funded project on music and wellbeing) (Gruntvig project report available from CCCU)
10. Global Alliance for Arts and Health, Washington, USA (the impact of the role of University researchers in establishing the international journal, `Arts and Health' as a conduit for researchers to reach practitioners and policy makers worldwide), (Report from Global Alliance for Arts and Health available from CCCU)