Community Health Intervention through Musical Engagement (CHIME) for Maternal Mental Health

Poor maternal mental health is a major global health challenge. Affecting up to one in five women, mental health conditions during and after pregnancy can have long-term adverse effects on women and children. Music has been termed the most ‘underutilized health asset on the planet’. It is innate, universal, low-cost, readily available, and increasingly recognized as an effective and versatile resource for health, including mental health and well-being. Engagement in group singing is linked with a myriad of positive effects including increased levels of joy, self-confidence, and social connection. Yet, there has been little rigorous research on the potential for music-based interventions to improve mental health. Previously, we partnered with community partners in the Gambia to develop the CHIME intervention for perinatal mental health: a novel, culturally-embedded, group-based singing intervention designed to improve perinatal mental health and well-being. We conducted a successful feasibility trial of the CHIME intervention and we now propose to evaluate the effectiveness of the intervention in the Gambia, as well as leveraging the widespread use of participatory music to initiate further programmes of research in new settings: South Africa and Lesotho. Our overall aim is to generate evidence on how culturally embedded music-based interventions can be used to improve maternal mental health, and build knowledge and capacity to support the evaluation, adoption and sustainable implementation across LMIC settings. Over a four year period we will engage in a number of different research activities to meet this aim. Specifically, we intend to: i) comprehensively map how the CHIME intervention works to inform intervention development, evaluation and implementation, using participatory Theory of Change workshops; ii) explore opportunities and develop partnerships for the future expansion of CHIME with a view to planning for its implementation in Lesotho, through a qualitative scoping study and partnership building activities; iii) adapt the CHIME intervention for use in South Africa using a co-development approach, iv) test the feasibility of evaluating CHIME through a cluster randomised controlled trial in South Africa; v) test the effectiveness, cost effectiveness of CHIME and assess proposed mechanism of action in the Gambia, and vi) co-develop plans for scaling CHIME and assess their budget impacts and return-on-investment with policy-makers. Across all research activities we will have a strong focus on building capacity for high quality research on using culturally-embedded music interventions to improve maternal mental health, with a view to leaving a positive legacy for communities, institutions, and services that is sustained beyond the grant period. To ensure integrity of the research and improve its reach and impact, our work is centred around a Community Engagement and Involvement approach, and we will work with perinatal women and their communities to equip, engage and empower them as research partners. Ultimately, we hope to use the knowledge generated through the CHIME activities to influence policy and practice in the development and implementation of participatory music-based interventions to promote maternal mental health across the study countries and regions.