Community of Voices Research

Study Design and Protocol

The Community of Voices study was a multi-site, “cluster-randomized” trial with the 12 senior centers serving as the “clusters.”  Each center was randomly assigned to receive the Community of Voices choir program immediately after enrollment ended or after a 6-month delay.  Thus, half of the senior centers started their choirs immediately, while the other half waited six months to start.  This study design was created with input from the senior center directors and the community music organization partner. 

Evaluation of the program consisted primarily of measuring changes in psychosocial, physical, and cognitive aspects of health and well-being.  Psychosocial outcomes included positive affect, interest in life, loneliness, depressive symptoms, and anxiety.  Cognitive outcomes focused on verbal memory (remembering a short list of words), attention, and executive function, all of which involve the ability to attend to a task and shift attention between several things.  Physical function outcomes focused on lower body strength, walking speed, and balance.  We measured health care utilization to determine if participation reduced the costs of healthcare.

Citation: Johnson JK, Nápoles AM, Stewart AL, Max WB, Santoyo-Olsson J, Freyre R, Allison TA, Gregorich SE. Study protocol for a cluster randomized trial of the Community of Voices choir intervention to promote the health and well-being of diverse older adults. BMC Public Health, 2015 Oct;15:1049. PMCID: PMC4603966

Outreach and recruitment.  We used a tailored recruitment approach for the study. UCSF developed tailored recruitment materials for each center, which were distributed to the centers and to others within its geographic service area using a variety of media (e.g., flyers, presentations, tabling, word-of-mouth, and radio). 

Citation: Johnson JK, Gregorich SE, Acree M, Nápoles AM, Flatt JD, Pounds D, Pabst A, Stewart AL. Recruitment and baseline characteristics of the Community of Voices choir study to promote the health and well-being of diverse older adults. Contemp Clin Trials Commun, Dec 2017; 8:106-113. PMCID: PMC5791898

Results of the Randomized Trial

The Community of Voices study is the largest randomized trial to test the impact of participating in a community choir on the health and well-being of ethnically diverse older adults.  The study involved 390 participants in 12 choirs.  The average age was 71 years, and participants reflected the rich cultural diversity in San Francisco.  Singing in the choir for six months showed positive results.  In particular, singing in a choir reduced feelings of loneliness and increased interest in life.  However, the cognitive and physical outcomes and healthcare costs did not change.  Singing in a choir can provide a meaningful, regular opportunity to meet new people, build social support, and increase a sense of belonging.  We know that staying connected to people is important for maintaining the health of older adults.  

Citation: Johnson JK, Stewart AL, Acree M, Nápoles AM, Flatt JD, Max WB, Gregorich SE. A Community Choir Intervention to Promote Well-being among Diverse Older Adults: Results from the Community of Voices Trial. J Gerontol B Psychol Sci Soc Sci. 2020 Feb 14;75(3):549-559. PMCID: PMC7328053

Perceived Benefits of Singing in a Choir

After completing the Community of Voices study, we queried participants about the types of benefit they perceived using a qualitative open-ended approach.  Resulting themes comprised most of the benefits assessed with our outcome measures.  However, three new psychosocial benefits that we did not anticipate included improved self-esteem, finding a place in society, and a sense of cultural identity and appreciation.  The increased awareness and strength of voice encompassed both a physical effect (e.g., improved breath) and psychosocial effects (e.g., assertiveness and finding one’s voice).

Citation: Allison T, Nápoles AM, Johnson JK, Stewart AL, Rodriguez-Salazar M, Peringer J, Sherman S, Ortez-Alfaro J, Villero O, and Portacolone E. Multi-cultural perspectives on group singing among diverse older adults. Geriatric Nursing 2020;41(6):1006-1012. PMCID: PMC7738424

Disseminating Study Results to Participants

The results of the Community of Voices study have been disseminated to the 12 senior participating senior centers through presentations by Dr. Johnson.  In addition, a 2-page newsletter/flyer that summarized the results and thanked participants in English and Spanish was sent to all participants. 

Sustainment of the Community of Voices Program

After completing the cluster-randomized trial, we assessed the sustainment of the Community of Voices choir program that was found to decrease loneliness and increase interest in life among diverse older adults. To examine key facilitators and barriers to continued participation and sustainment of the program, we conducted semi-structured individual and focus group interviews with four key stakeholder groups: music professionals, administrators, and trial participants who did or did not continue.

        Citation:  Allison et al. (submitted)

How to Select Outcomes of Choir Interventions

For those interested in implementing and evaluating a community choir, we propose a set of potential outcomes based on prior research and our own findings.  These outcomes take the form of a multi-dimensional conceptual framework of potential benefits for older adults of singing in a choir.  This framework is a result of a series of studies.