Sustaining community choirs for diverse older adults after completion of the Community of Voices trial: A multi-stakeholder, multi-site qualitative study

Background The growing and increasingly diverse U.S. aging population needs sustainable, evidence-based interventions to maintain health and independence in the community. Through a three-way collaboration between a university research partner, an aging services partner and a community music partner, we developed and tested a senior center-based choir intervention for ethnically diverse older adults that decreased loneliness and increased engagement. We now report on the key factors affecting sustainment, defined by continuation of the choirs after the completion of the trial and ongoing participation of older adults. Methods Of the twelve choirs in the study, five were provided with additional funding to sustain the choirs for an additional six months, without technical support from the researchers. During this sustainment period, semi-structured individual and focus group interviews were conducted with key stakeholders (trial participants who continued in the choirs, music professionals, and administrators). We explored facilitators and barriers to continued participation in the choirs and sustainment of the choirs themselves by the senior centers and music professionals. Transcripts were open coded using ATLAS.ti by two researchers not involved in the original CRT, followed by axial coding by a third researcher. Differences were reconciled by discussion. Results Salient themes emerged at all levels. Intrapersonal: a sense of well-being and positive emotion facilitated choir participation, and sustainment of the choirs, but major health issues and negative emotions led trial participants to discontinue the choirs at the end of the trial. Interpersonal: a sense of social connection and support facilitated sustainment, but negative social interactions and competing obligations, particularly participants’ family responsibilities, created barriers. Structural/organizational: organizational features such as comfortable rehearsal space or clear scheduling, facilitated sustainment, but structural issues with parking and transportation created barriers. Administrators emphasized funding as crucial to sustainment. To date, all of the choirs from the original CRT have been sustained and the community partners are actively disseminating the intervention outside of the research setting. Conclusions Senior center-based choirs are readily sustainable. A conceptual model is provided to guide the implementation of future choirs and other community-based social interventions. Trial registration: The original trial was registered under ClinicalTrials.gov. NCT01869179. Registered 9 January 2013, https://clinicaltrials.gov/ct2/show/NCT01869179