No abstract

ObjectivesExamine the feasibility of a Community Health Intervention through Musical Engagement (CHIME) in The Gambia to reduce common mental disorder (CMD) symptoms in pregnant women.DesignFeasibility trial testing a randomised stepped-wedge cluster design.SettingFour local antenatal clinics.ParticipantsWomen who were 14–24 weeks pregnant and spoke Mandinka or Wolof were recruited into the intervention (n=50) or control group (n=74).InterventionMusic-based psychosocial support sessions designed and delivered by all-female fertility societies. Sessions lasted 1 hour and were held weekly for 6 weeks. Delivered to groups of women with no preselection. Sessions were designed to lift mood, build social connection and provide health messaging through participatory music making. The control group received standard antenatal care.OutcomesDemographic, feasibility, acceptability outcomes and the appropriateness of the study design were assessed. Translated measurement tools (Self-Reporting Questionnaire (SRQ-20); Edinburgh Postnatal Depression Scale (EPDS)) were used to assess CMD symptoms at baseline, post-intervention and 4-week follow-up.ResultsAll clinics and 82% of women approached consented to take part. A 33% attrition rate across all time points was observed. 72% in the intervention group attended at least three sessions. Audio and video analysis confirmed fidelity of the intervention and a thematic analysis of participant interviews demonstrated acceptability and positive evaluation. Results showed a potential beneficial effect with a reduction of 2.13 points (95% CI (0.89 to 3.38), p<0.01, n=99) on the SRQ-20 and 1.98 points (95% CI (1.06 to 2.90), p<0.01, n=99) on the EPDS at the post-intervention time point for the intervention group compared with standard care.ConclusionResults demonstrate that CHIME is acceptable and feasible in The Gambia. To our knowledge, CHIME is the first example of a music-based psychosocial intervention to be applied to perinatal mental health in a low- and middle-income country context.Trial registration numberPan African Clinical Trials Registry (PACTR201901917619299).

Summary Arts in Health initiatives and interventions to support health have emerged from and been applied to mainly WEIRD (Western, Educated, Industrialized, Rich and Democratic) contexts. This overlooks the rich cultural traditions that exist across the globe, where community groups often make prolific use of participatory song and dance as a part of ceremonies, ritual and gatherings in everyday life. Here, we argue that these practices can provide a valuable starting point for the co-development of health interventions, illustrated by the CHIME project for perinatal mental health in The Gambia, which worked with local Kanyeleng groups (female fertility societies) to design and evaluate a brief intervention to support maternal mental health through social singing. Here, we use the project as a lens through which to highlight the value of co-creation, cultural embeddedness and partnership building in global health research.

Kanyeleng fertility society musicians have become an integral part of health promotion programs in the Gambia. Health workers have embraced kanyeleng performance in the name of making their programs more participatory and therefore more effective in combatting persistent health problems. While participation has become a buzzword in global health discourse, the contested social relations of musical performances have not been adequately examined. Bringing a medical ethnomusicological perspective to interdisciplinary debates on participation, this article foregrounds the participatory dynamics of music making as they intersect with local concepts of music, health, and well-being.

No abstract