A realist evaluation of participatory music interventions for wellbeing: what works, for whom and in what circumstances

Background: The connections between music and wellbeing are well recognised. In the current climate of economic austerity, there is a growing demand for more robust evidence of the benefits of music-based interventions to make the best use of limited arts and health resources. Aims: To explore the connections between participatory music activity and self-defined wellbeing concepts. In particular, this study seeks to identify mechanisms that connect specific types of group music activity with specific wellbeing outcomes for people with mental health issues and/or learning disabilities. Research question: What are the mechanisms that connect music and wellbeing for people in challenging circumstances? What works, for whom and in what circumstances? Design: A Realist Evaluation approach was used to identify and explore generative mechanisms in social music programmes that give rise to specific wellbeing outcomes. Two music programmes were investigated and a focus group was carried out with a third programme for validation purposes. Participant-observation and semi-structured interviews were used to identify programme theories (theories that explain outcomes), which were further developed and refined through iterative data accrual. Findings: Six programme theories were identified. Song writing and recording projects that involved both technical and artistic choices had an engaging effect, leading to outcomes of praise, hope and self-advocacy (with a corresponding sense of empowerment). Forms of musical improvisation tended to affect energy levels and consequently mood and perception, yielding both immediate effects (expressed as a sense of ‘balance’) and subsequent effects (described here as resilience). Activities involving pre-existing songs or styles (e.g. cover versions) engaged notions of identity and memory, which affected mood and increased wellbeing. Conclusion: The programme theories identified here have the potential to inform and improve music for health programmes in other contexts. Useful similarities and significant differences between service user groups were identified, enabling more specific questions to be asked of music programmes and indicating directions for future inquiry. These findings may enable similar interventions to be better tailored to their client base, making them more effective and more cost-effective