The use of music as an arts-based method in migrant health research: a scoping review protocol

Introduction

There are rising imperatives for involving the public in health decision-making. The rationale comes from several sources (Gibson et al., 2012) but includes an increasing recognition that people have lived experience of health and, thus, are experts whose experiential knowledge needs to be incorporated into analysis to ensure a comprehensive epistemic baseline (Popay & Williams, 2006). This patient and public knowledge has a key role to play in the promotion of good health; (Ascenso et al., 2018; Brown et al., 2018; Jones et al., 2013; Roberts et al., 2017; Tarr et al., 2014) prevention of ill health; (Chabot et al., 2019; Conceição et al., 2016; Fancourt & Perkins, 2018a) managing and treating illness; (Cao et al., 2016; Gopalkrishnan 2016; Wan et al., 2010) the development of health services and strategy (WHO Europe, 2002; WHO, 2018) as well as health research (HRB Strategy 2016-2020; Horizon 2020; Ramsden et al., 2010; Wallerstein et al., 2018), which is the focus of this article.

There have been significant advances in the field of involving the public in health research. In spite of challenges with conceptualisation (Sarrami-Foroushami et al., 2014), there is an acknowledged need for expanding the evidence base around meaningful, rather than tokenistic, involvement drawing on a variety of research traditions and methods (Chew-Graham, 2015). There are specific areas that require further development including patterns of exclusion whereby migrant’s involvement in health decision-making is rare (de Freitas & Martin, 2015; MacFarlane, 2019). However, there are complexities in accessing and understanding this experience. ‘Migrants’ are a heterogenous group of peoples. There is no agreed universal definition for a ‘migrant’. The broadest one, from the International Organisation for Migration is ‘anyone who has moved from their habitual residence (within or across borders)’. The term ‘migrant’ can refer to students, family reunification, labour migrants (moving to higher/lower paid employment), people seeking protection, people who are trafficked and so on. Further still, migrants’ identities and experiences are not only defined by this issue of ‘movement’ but, also, by gender, ethnicity, class and culture. Intersectionality captures this complexity (Crenshaw, 1995). Finally, migrants have different health experiences but also share health experiences with the people in the communities in which they settled. While there are specific health implications of pre-migration and migration journeys (trauma, screening), migrants have non-communicable diseases and considerable health needs in relation to these, just like host populations (WHO Europe, 2018).

There is a view that these patterns of exclusion exist because migrants are hard to reach or easy to ignore (Lightbody, 2017). This view focuses on challenges in access and communication and concerns about the additional work and resources that health researchers would need to involve migrants. Certainly, there are issues to consider. These include cross-cultural interactions between migrants and health researchers (O'Reilly-De Brún et al., 2018); concerns for migrants about safely interacting with academia/officialdom (van den Muijsenbergh et al., 2016); and problems with representation of power, particularly given the heterogeneity of migrant experiences (De Freitas et al., 2014; Vaughn et al., 2017).

Given the ethical imperatives for migrants’ involvement and the anticipated benefits for a more comprehensive knowledge base, which incorporates their expertise, a key question is how best to involve migrants in health research and, further, what is the evidence of best practice in terms of ethics, ontology and methodology? Migration and mobility create inevitable challenges around social inclusion and this extends to social and cultural practices used in research (Rubina et al., 2010). Therefore, in order to optimise migrants’ involvement in health research we need to think creatively and innovatively about effective strategies to enable and ensure meaningful participation. Participatory Health Research is a paradigm which centralises participation from the outset to the completion and dissemination of research. It emphasises shared governance and community ownership (Wright, 2015). There is a rich tradition of participatory approaches that provide valuable tools, practices and techniques that have relevance for this endeavour (MacFarlane, 2019).

We know that participatory spaces are shaped by using these tools, practices and techniques to create and support dialogues between stakeholders (Cornwall & Schatten Coelho, 2007; Massey, 2005; Power, 2001). There is evidence that the use of inherently analytic and visual tools and techniques from the Participatory Learning and Action (PLA) research approach, for example, can be used to involve migrants in meaningful and impactful dialogues with stakeholders from universities and health care sectors (de Brún et al., 2017; O'Reilly-De Brún et al., 2018). PLA does still, however, centre around knowledge sharing via language so it is valuable to think about other forms of communication and interaction that may be useful to complement or augment such approaches. Within music research, there is compelling evidence that certain musical practices, such as singing, are particularly effective in fostering participation through increasing empathy (Ahlquist, 2006; Bithell, 2014; Clarke et al., 2015; Magowan, 2019; Phelan, 2017a), accelerating interaction within new and diverse groups (Pearce et al., 2015) and facilitating multi-modal communication beyond the semantic limits of language (Welch et al., 2014). Studies demonstrate the value of music as a participatory strategy in a wide range of health and well-being areas including mother-infant bonding (Cevasco, 2008; Fancourt & Perkins, 2017; Fancourt & Perkins, 2018b; Persico et al., 2017), speech and language (Brown et al., 2018; Cogo-Moreira et al., 2013; Flaugnacco et al., 2015), pain management (Chuang, 2018; Gokyildiz Surucu et al., 2018), hypertension (Cao et al., 2016; do Amaral et al., 2016; Kühlmann et al., 2016), cognitive decline (Gooding et al., 2014; Strong & Mast, 2019), ageing and frailty (Chabot et al., 2019; Trombetti et al., 2011; Ueda et al., 2013), trauma and abuse (Bronson et al., 2018; Carr et al., 2012; Landis-Shack et al., 2017), surgery (Dionigi & Gremigni, 2017; Jayakar & Alter, 2017; Nilsson, 2009), perinatal care (Chang et al., 2015b; Fancourt & Perkins, 2018b; McCaffrey et al., 2020; Perkins et al., 2018; Reilly et al., 2019), physiotherapy (Hsu et al., 2016; Lim et al., 2011), autism (Cook et al., 2018; LaGasse, 2017; Woodman et al., 2018), cerebral palsy (Alves-Pinto et al., 2017; Bringas et al., 2015; Marrades-Caballero, 2018), stroke (Fogg-Rogers et al., 2016; Forsblom et al., 2010; Raglio et al., 2017; Tamplin et al., 2013), other acquired brain injuries (Baker et al., 2018; Baker et al., 2019; Roddy et al., 2018; Tamplin et al., 2013), Parkinson’s Disease (Barnish et al., 2016; Di Benedetto et al., 2009; Evans et al., 2012; Han et al., 2018; Harrison et al., 2017; Stegemöller et al., 2017; Tanner et al., 2016), and dementia (Chang et al., 2015a; Daykin et al., 2017; Dowlen et al., 2018; Moss & O’Neill, 2019; Särkämö et al., 2014). The specific literature around music and migrant health and well-being is also growing (Balsnes, 2016; Cain et al., 2020; Henderson et al., 2017; Phelan, 2017b; Phelan et al., 2017).

Despite the numerous publications on the role of music in health and well-being, it is striking that an examination of reviews to date on the use of arts-based methods in health identify very few studies using music as an arts-based research method. The inclusion of artistic practices as methodological tools in research is frequently labelled arts-based research (ABR). A useful definition of ABR is provided by Leavy as, “a set of methodological tools used by qualitative researchers across the disciplines during all phases of social research, including data collection, analysis, interpretation and representation … arts-based practices draw on literary writing, music, performance, dance, visual art, film and other mediums” (Leavy, 2009, p.ix).

The systematic review of arts-based methods in health research by Fraser & al Sayah, (2011) identified 30 articles using a variety of arts-based methods including photography (11), drawing (10), theatre (7) and poetry (2) but none of the studies specifically mentioned music. Boydell et al. (2016) identified 71 papers in their scoping review of arts-based health research using photography (23), theatre (21), drawing (8), film (8), poetry (3) and dance (1). Though eight studies used a variety of artistic practices, none of them mentioned music specifically. Coemans & Hannes, (2017) identified photography, theatre and poetry as the most often used artistic practices in ABR. Thus, while it is clear that music is being used as a tool of participation in health contexts, its role as a research tool is less well defined. A number of reasons may be suggested for this apparent anomaly.

Firstly, much of the research on the role of music in health and well-being is observational. For example, in the review carried out by Fraser and al Sayah, 30 articles were identified as using ABR but 56 were excluded as they did not use the artistic practice as part of the research method (Fraser & al Sayah, 2011). Such research observes and reports on the impact of music in health and well-being contexts, but does not use the arts as a research tool. In the case of music, the music practice becomes an object of study, rather than an intrinsic part of the research design, implementation or interpretation. Participation may be an important element of the observed practice, but not necessarily an aspect of the research method.

Secondly, there is a lack of consensus concerning the terminology used to describe research through the arts. The term arts-based research was first coined in the early 1990’s by Elliot Eisner (Eisner, 2008; Barone & Eisner, 2012) and while it has steadily grown in usage since that time, there is still a great deal of research through the arts (including research in areas such as music therapy, community music and music education) which does not use this terminology. This is especially the case in health research, which has adopted the use of ABR terminology more slowly than, for example, creative arts practices, education, community-based research (Ledger & McCaffrey, 2015). The growing area of practice as research (PaR), also variously known as arts practice research, artistic research, arts practice research and practice-based research, further complicates the terrain (Nelson, 2013; Smith & Dean, 2009). Debates regarding nuances of meaning have resulted in a plethora of terms which often confuse rather than clarify the discourse (Chilton, 2013).

Another important factor includes understandings of what constitutes health research. The WHO definitions of health (Fancourt & Finn, 2019, p.2) and art (ibid, p.1) note that health is inclusive of individual, social and cultural wellbeing and that artistic practices also extend across individual, social and cultural spaces. Blacking’s definition of music as ‘humanly organised sound’ (1973, p.10) was a direct response to narrower, ethnocentric definitions based on Western European aesthetics. These inclusive definitions challenge researchers to look beyond traditionally recognised health literature and disciplines to include health research carried out through music but published in areas such as ethnomusicology, cultural and social anthropology or community arts among others.

Finally, as Coemans and Hannes note, ABR is sometimes applied quite narrowly within the research design: “traditionally, ABR methods have been applied either as a data collection technique or as a dissemination technique” (2017, p.35). However, in ABR approaches, “the arts play a primary role in any or all of the steps of the research method” (Austin & Forinash, 2005, p.458-459) in order to exploit “the capacities of expressive form to capture qualities of life that impact what we know and how we live” (Barone & Eisner, 2012, p.5). A narrow application of the term often describes a process whereby artistic participation starts at the point of data generation or collection, but music is also used very successfully as a tool for initiating and creating partnerships for research. Research frameworks or reviews which do not utilise an explicitly articulated participatory approach often fail to capture or identify this music-based research as ABR.

For these reasons, a scoping review conducted by an interdisciplinary team which focuses specifically on the use of music as an arts-based method is both necessary and challenging. In order to develop optimal modes of participatory research using music as an arts-based method to inform the field of migrant health research, we need to analyse existing evidence across disciplines that are not usually studied together by health researchers, identify gaps in current knowledge and use these as a foundation to build effective strategies towards increasing access to and knowledge of participatory, arts-based methods using music in migrant health research. These approaches should apply our knowledge of music as a participatory strategy and adapt it for the purposes of research so that it is ethically guided to yield knowledge that cannot be accessed, analysed or represented through standard research frameworks and modes of communication (Barone & Eisner, 2012). In addition, it is important to document the capacity of music to facilitate participatory spaces for building trust, raising participant voices in their own words and ways, and triggering empathy and understanding that leads to action (Bartleet et al., 2010; Bartleet & Higgins, 2018; Bonshor, 2018; Higgins et al., 2010). This is very much in line with the aforementioned principles of PHR (Wright, 2015).

Methods

Due to the broad nature of the research question and objectives, we want to specifically capture the extent of the literature that utilises music as an ABR method in migrant health research in order to identify its evidence base. We aim to identify if and how music is being utilised as an ABR method in the field of migrant health research. With that in mind, a scoping review was identified as the most suitable methodology to help clarify key concepts and understand the extent of the evidence across disciplines around the use of music as an ABR tool in migrant health research. It is envisaged that a scoping review conducted in a systematic way can assist practitioners and policy makers in the area of migrant health research. To ensure rigour in our approach, the protocol for this scoping review follows the guidelines and stages set out in the JBI Reviewer’s Manual (Peters et al., 2017), and by Levac et al., (2010), which consist of a further developed methodological framework from that of the widely cited Arksey & O’Malley (2005). The extended framework from Levac et al., incorporates six stages: 1) Identifying the research question; 2) Identifying relevant studies; 3) Study selection; 4) Charting the data; 5) Collating, summarising, and reporting results; and 6) Consultation. This protocol will outline how we will address each of the six stages.

Ethics and dissemination

Study status

Database searches have been completed. Titles and abstracts have been screened and full texts are being assessed against the eligibility criteria.

Data availability

No data are associated with this article.