Implementation of singing groups for postnatal depression: experiences of participants and professional stakeholders in the SHAPER-PND randomised controlled trial

Emeline Han^1*Rachel Davis^2,3Tayana Soukup^3,4Alexandra Bradbury¹Julie Williams³Maria Baldellou Lopez³Lorna Greenwood⁵Rebecca Bind⁶Carolina Estevao⁶Tim Osborn⁵Hannah Dye⁵Kristi Priestley⁶Lavinia Rebecchini⁶Katie Hazelgrove⁶Manomani Manoharan⁷Anthony Woods⁶Nikki Crane⁸Andy Healey³Paola Dazzan⁶Nick Sevdalis⁹Carmine M Pariante⁶Daisy Fancourt¹Ioannis Bakolis^10,3Alexandra Burton¹

• ¹Department of Behavioural Science and Health, University College London, London, England, United Kingdom
• ²Evidera, INC. PDD, part of Thermofisher Scientific, London, United Kingdom
• ³Centre for Implementation Science, King's College London, London, England, United Kingdom
• ⁴Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, England, United Kingdom
• ⁵Breathe Arts Health Research, London, United Kingdom
• ⁶Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, England, United Kingdom
• ⁷South London and Maudsley NHS Foundation Trust, London, United Kingdom
• ⁸Culture Team, King's College London, London, United Kingdom
• ⁹Centre for Behavioural and Implementation Science Interventions, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
• ¹⁰Department of Biostatistics & Health Informatics, School of Mental Health & Psychological Sciences, King's College London, London, England, United Kingdom

Background: There is a rapidly growing evidence base for the effectiveness of creative health interventions in improving mental health, but few studies have explored implementation and scaling of these interventions. The aim of this study was to evaluate the perceived acceptability, appropriateness, and feasibility of a ten-week singing group programme (Breathe Melodies for Mums (M4M)) for mothers experiencing symptoms of postnatal depression (PND) and their babies as well as the programme ingredients that affected these implementation outcomes. Methods: A mixed methods design was adopted. Quantitative data was collected via the Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM), and Feasibility of Intervention Measure (FIM) from 109 intervention participants at 6, 20, and 36 weeks and analysed descriptively. Qualitative semi-structured interviews were conducted with 22 programme participants and 15 professional stakeholders involved in implementing the programme. Qualitative data were analysed using framework analysis.Results: Quantitative results showed high levels of acceptability, appropriateness, and feasibility among M4M participants, with median scores of 5/5 achieved on the AIM, IAM and FIM at 20 and 36-week follow up. Qualitative results gave insights into the ingredients of M4M that made the programme acceptable, appropriate, and feasible to participants and professional stakeholders. These included ‘project’ ingredients (dose, design, content), ‘people’ ingredients (social composition, activity facilitation), and to a lesser extent, ‘context’ ingredients (setting, project set-up). While participant and stakeholder experiences were largely positive, some challenges and suggestions for improvement were also identified including broadening recruitment strategies to reach more women.Conclusion: M4M was highly acceptable, appropriate, and feasible to participants and stakeholders. By identifying the ‘core’ ingredients that facilitated implementation success and strategies to address implementation barriers, these findings have important implications for future implementation and scale-up of M4M and similar creative health programmes. Trial Registration Number: ClinicalTrials.gov ID NCT04834622Date of registration: 04/08/2021