Health and Wellbeing for Musicians: Course Evaluation

Background
In our systematic review of health promotion programmes and intervention studies we identified methodological limitations including the incorporation of non-evidence-based elements and the use of unvalidated questionnaires as evaluation tools. The research was undertaken in an attempt to address these limitations, and also to introduce and assess the effectiveness of behavior change techniques applicable equally to health-related behaviors, time manage-ment, and practice and rehearsing.

Aims
The evaluation was designed to obtain students’ feedback on the course and to measure potential changes in their attitudes and behaviors over the six months that it lasted.

Method
Ethical approval was sought and granted from the RNCM Research Ethics Committee to carry out a questionnaire survey with first-year students. Baseline data were obtained at the start of the course and the same questionnaire was administered at the end, as part of the students’ assessment. Items included demographics, health-related quality of life (EQ-5D; 15D), positive and negative emotions (PANAS), PRMDs (pain frequency and intensity and perceived exertion via the Rating of Perceived Exertion (RPE) scale), perceived stress (PSS), health-promoting behaviors (HPLP II), self-efficacy (SES), work patterns, hearing loss and use of hearing protection, as well as perceived knowledge, competency, awareness, responsibility, and attitudes towards health and wellbeing. Interview data were obtained from 20 students when the questionnaire data had been analyzed.

Results
At baseline, 90 students who completed the questionnaires (46% male, 52% female), 13% reported moderate prob-lems with sleeping, 11% felt moderately sad, melancholic, or depressed, 9% felt moderately weary, tired, or feeble; 5% reported hearing normal speech with a little difficulty, 8% reported having tinnitus and 6% reported hyperacusis. The severity of PRMDs was surprisingly low (M=2.23 out of 10). Our results confirmed previous findings in that re-spondents showed lower scores for health responsibility, physical activity, and stress management than nutrition, spiritual growth, and interpersonal relations. In addition, perceived stress was negatively correlated with self-efficacy, positive affect, and health-promoting lifestyle. Self-efficacy was negatively correlated with perceived stress and positively correlated with positive affect and health-enhancing behaviors. Sleeping problems were correlated with affect (negatively with positive affect and positively with negative affect), positively with perceived stress, de-pression, distress, and lack of vitality, and negatively with self-efficacy. After two terms, positive affect had de-creased. Students reported significant increases in their perceived awareness of risk factors for PRMDs, and significant increases in their perceived knowledge of effective strategies for practicing, learning, and memorizing; rehearsing; ergonomics and posture; management of music performance anxiety; life skills and behavior change techniques; resources for healthy music-making; and sound intensity levels associated with hearing loss. Interview data suggested that students had made changes to their behaviors and implemented some of the techniques they had learned in the workshops on life skills in their practice and rehearsal; they listed the sessions they found most useful and made valuable suggestions for modifications to the course that will be put into practice in 2017-2018.

Conclusions
This is one of the very few evidence-based health promotion courses for music students that have been evaluated to date. Quantitative and qualitative analyses of data have provided useful information with respect to both patterns in changes related to relevant outcomes, and students’ perceptions of and suggestions for the course to inform future improvements.