Summary of the impact

This case study describes the reach and significance of research conducted by members of the interdisciplinary Sidney De Haan Research Centre for Arts & Health. The examples below focus on the impact of singing as a health and wellbeing intervention for adults within clinical and non-clinical populations. The research has shown that singing has had a beneficial impact on individuals and influenced fields of professional practice in health and social care in the UK and US, service delivery in the UK, and policy development in the UK through the work of the Royal Society for Public Health.

Underpinning research

From 2004 the Sidney De Haan Research Centre for Arts & Health at Canterbury Christ Church University (CCCU) has been developing an international profile for research on the benefits of singing for health. Professor Stephen Clift heads the Centre, whose work was reflected in the University's RAE submission in 2008. Clift has been instrumental in developing the arts and health research field internationally, beginning with his initial exploratory study in 2001; he and Centre colleagues have built on the aims of the previous RAE, by developing a progressive programme of quantitative, mixed-methods and qualitative research developed with the support of external research grants.

In order to better understand the current state of the field, in 2010 Prof Clift, Dr Ian Morrison and colleagues completed the first reported systematic review of singing, health and wellbeing (4). This laid the foundation for subsequent research to further develop the underlying evidence for singing and health: Drs Livesey and Morrison along with Professors Clift and Camic (5) undertook a large-scale cross-national study of choral singing in Australia, England and Germany, involving over 1,000 people; results indicated that psychological, social, spiritual and physical wellbeing can be improved by regular group singing for people who choose to sing. This followed with a large-scale evaluation of singing groups (1), established for older people involving over 300 people without a history of regular singing, that provided evidence of psychological and social benefits. A theoretically focused study was completed in 2010 (6) that provided a deeper understanding of the components and mechanisms of group singing.

Undertaking research with clinical populations, in 2011 Prof Clift and Dr Morrison completed a longitudinal study of group singing involving over 100 people with a history of enduring mental health problems (3), which demonstrated a significant improvement in mental wellbeing using a validated clinical measure widely employed in mental health services for screening and evaluation. Prof Camic later that year completed a first of its kind mixed-methods longitudinal study on the impact of a ten week group singing programme on people with dementia and their family carers (2) that was subsequently adopted by the Brighton & Hove Primary Care Trust.

Building on the above work, in 2012 Dr Skingley and Prof Clift completed an RCT funded by the Research for Patient Benefit programme (NIHR) on the wellbeing and health benefits of group singing for people aged 60 and over. With more than 300 people randomised into singing and non-singing groups, the results demonstrated significant positive difference for participants in singing groups on measures of mental wellbeing at the end of the intervention and on a further three-month follow up (report available at: www.canterbury.ac.uk/research/centres/SDHR)

References to the research

Quality of the research

Peer review: All cited outputs involved blind peer review by journal editorial boards and outputs 1-5 have received external funding.

The research has resulted in invitations for keynote addresses to international (Health & Society conference, Trondheim, Norway, 2012) and national (SEMPRA, 2011, 2012, 2013) conferences. In recognition of his research in arts and public heath, Professor Clift was appointed as a Professorial Fellow (2011) to the Royal Society for Public Health (RSPH) and from 2009 has been appointed chair of the annual RSPH Arts and Health Awards for best practice and research in the UK.

As further evidence of research quality, the CEO of the Royal Society for Public Health (RSPH) invited Professors Clift and Camic to join the RSPH Arts, Health and Wellbeing working group in 2012 to develop a major policy report to guide future developments in the public heath and healthcare sectors in the UK and internationally.

Funding: The above research has been supported by a series of grants for the research and/or its dissemination or extension: Roger De Haan Charitable Trust £600K (2004-2010); Eastern and Coastal Kent PCT £100K (2009-2010); Dorothy Allen Trust £18.5K (2009); Dunhill Medical Trust £130K (2010-2012); RfPB, NIHR with Eastern and Coastal Kent PCT; £250K (2010-2011); Oak Foundation £300K (2011-2014); Kent and Medway Partnership Trust £25K (2011-2012); West Kent Clinical Commissioning Group Consortium £140K (2013-2015). Total: £1,563,500

Details of the impact

Impact on people with long-term conditions

Corroborating sources are numbered in brackets

1. Sing For Your Life charity, established 2005, as an initiative of the Centre to be able to transfer research findings to practice. Sing For Your Life runs over 40 singing groups for older people across the South East and elsewhere in the country reaching over 1,000 older people in community and care settings every month. Singing groups have also established in Canada, Finland and Italy following the model we devised. Qualitative evaluation, surveys and a pragmatic community-based RCT funded by NIHR, have provided evidence of significant effects of regular group singing for the mental wellbeing of older people. (www.singforyourlife.org.uk) (1)

2. Living Lively charity established 2010 as a direct result of the NIHR RCT. Over 300 people aged 60+ took part in the NIHR study, and half of them were randomised to five singing groups, which met weekly during April to June 2010. There was considerable enthusiasm for the groups and Living Lively was established by one of the musicians who facilitated groups as part of the study. Singing groups continue to meet weekly involving over 500 people across several counties. (www.livinglively.org.uk) (8)

3. East Kent Singing for Mental Health Network This network of singing groups for mental health service users with enduring mental health problems was established in 2009 in collaboration with the Centre, 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. Groups have come together for large public performances on two occasions. This led to the award of further NHS funding to extend the network into West Kent and Medway. (2, 4, 9)

4. East Kent Singing and COPD Network This network of singing groups was established 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 120 people with chronic obstructive pulmonary disease (COPD) meet weekly to participate in a programme of singing designed to promote better breathing. (6)

5. Skylarks — Singing for Parkinson's singing groups have been established in Kent in collaboration with local Parkinson's Society support groups. Over 60 people with Parkinson's and carers participate on a two-weekly basis in a programme of singing designed to help maintain and improve voice quality (http://www.canterburycantatatrust.co.uk/skylarks/4579791546). (6)

6. Brighton and Hove PCT singing groups of people with dementia As a direct consequence of research on singing and dementia conducted by Centre staff, Brighton and Hove PCT provide monthly singing groups for this population reaching over 80 people.(5)

Impact on practitioners, training and public opinion

1. Royal Society for Public Health (RSPH) made a policy decision in 2008 to more fully incorporate and recognise the work of arts and health practitioners, initially in the area of music and singing, and based on Sidney De Haan Research Centre work, formed a national awards committee to assess innovation and excellence in UK arts and health practice. In 2012 the RSPH, recognising the growing research base in music, singing and public health from the Sidney De Haan Research Centre held the UK's first national one-day conference on arts, wellbeing and public health practice. Also in 2012 the RSPH developed the first national public health practitioner training programme in arts, health and wellbeing (New Horizons), based on research of several Centre staff. The training includes modules on singing and health focusing on mental and physical health problems, using the research findings to influence the content (research references 1-6). (3, 7)

2. Global Alliance for Arts & Health (Washington, DC) In 2008 the Alliance, with over 2,000 international members, invited Professors Camic and Clift to establish Arts and Health: An International Journal for Research, Policy and Practice, the first international journal of its kind, now in its fifth year. The journal has been cited in the House of Lords, US Congress and the Royal Society for Public Health for its contributions to practice development, research and health care policy, thus having an impact on public opinion. (10)

Sources to corroborate the impact

1. Sing For Your Life charity (the impact of research on the expansion of Sing For Your Life and its success in securing funds to establish singing groups for older people) CEO (contact I.D. 1)
2. Eastern and Coastal Kent Primary Care Trust (now Public Health England) (the impact of research on singing for mental health service users and a NIHR-funded RCT on singing for older people. PCT now dissolved) Assistant Director for Public Health for Kent (contact I.D. 2)
3. House of Lords Policy Debate on Arts Contribution to Education, Health and Emotional Wellbeing: Hansard Report 25.7.13 column 1508
   http://www.publications.parliament.uk/pa/ld201314/ldhansrd/text/130725-0003.htm
4. Kent and Medway Partnership Trust (the impact of research on singing and mental health services) Lead Occupational Therapist (contact I.D. 3)
5. Brighton and Hove Primary Care Trust (the development of fortnightly dementia and singing groups from 2.1.10-1.4.13 when the PCTs were dissolved)
   http://www.bhlink.org/res/media/pdf/WebsiteVersionLINKMagazineNovember2012.pdf
6. Medical Conditions: British Lung Foundation (the impact of research on the development of group singing programmes for people with chronic respiratory illness) National Services Manager (contact I.D. 4) and Canterbury Cantata Trust, Skylarks Choir (the impact of singing on those with Parkinson's disease) Choir founder (contact I.D. 5)
7. Royal Society for Public Health policy statement: Arts, Health and Wellbeing beyond the Millennium: How far have we come and where do we want to go? (June 2013) is available at: http://www.rsph.org.uk/en/about-us/policy-and-projects/arts-and-health//
8. Living Lively, a registered charity (the impact of singing on the health and wellbeing of people over 50). http://livinglively.org.uk/
9. Kent and Medway Health and Europe Centre (the impact of research on singing and health on health professional's practice engaged in the Grundtvig funded project on music and wellbeing) (Gruntvig project report available from CCCU)
10. Global Alliance for Arts & 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)
    http://thesah.org/template/page.cfm?page_id=445