Enhancing Health in Rural Populations: Music as Therapy
Phase: NA
Conditions: Stress, Generalized Anxiety, Chronic Pain, Depression Disorder
Sponsor: Northern Arizona University

COVER PAGE  
 
Study Title: Enhancing Health in Rural Populations: Music as Therapy 
 
Clinical Trials Registration Number: NCT not yet assigned  
 
Date of document: April 7, 2026 
 

Study Protocol 
 
Background 
Since the COVID-19 pandemic, approximately one in five adults in Arizona report symptoms of 
mental health disorders each year.1 These outcomes are particularly concerning in rural and 
medically underserved areas, where long-term care residents face elevated risks of chronic 
stress, cognitive decline, physical pain, and social isolation.1 Older adults with memory-related 
impairments are especially vulnerable to the loss of meaningful interpersonal and sensory 
engagement.1  
 
Music-based interventions (MBIs) have demonstrated strong potential to support both cognitive 
and emotional well-being.2 Existing studies report significant analgesic effects of music and 
reductions in symptoms of anxiety, stress, and depression, supporting the use of MBIs as non-
pharmacological health interventions.3,4 However, there is limited research examining how 
familiarity, personalization, and continuity of musical exposure influence intervention outcomes 
among older adults with cognitive or emotional health challenges, particularly those living in 
long-term care settings. 
 
Older adults with cognitive impairment often experience reduced autonomy, fragmented social 
networks, and limited access to therapies that support holistic well-being.2 Despite the frequent 
use of music in caregiving environments, few interventions have been systematically adapted or 
rigorously evaluated. This study addresses that gap by evaluating a structured music-based 
intervention designed to support mental and physical health among adults residing in two long-
term care communities in northern Arizona. 
 
Study Design 
This study uses a single-group quasi-experimental design with pre- and post-intervention 
assessments. All participants will receive the same music-based intervention and will complete 
surveys prior to the first session and again after the completion of the six-week program. In 
addition, a subset of participants, facilitators, and musicians may be invited to participate in 
qualitative interviews to provide more detailed information about their experiences with the 
intervention. 
 
Setting 
The study is being conducted at two residential long-term care communities in northern Arizona: 
Haven Health and The Peaks. These settings serve adults who may be experiencing physical 
health challenges, emotional distress, cognitive impairment, and limited access to behavioral 
health resources. 
 
Intervention Description 
Participants will engage in a six-week music-based intervention delivered in a group format. 
Sessions will occur once per week and will last approximately 60 minutes. The intervention 
emphasizes active music participation rather than passive listening and includes activities such 
as drumming, rhythm exercises, flute music, and other culturally grounded music practices led 
by experienced musicians. 
 
The curriculum has been refined through collaboration with a Community Advisory Board, care 
staff, and local musicians to ensure that it is contextually appropriate and therapeutically 
relevant for older adults in long-term care settings. Particular attention has been given to 
creating an intervention that is engaging and accessible for participants with varying levels of 
cognitive functioning. 

 
Recruitment 
Participants will be recruited directly through Haven Health and The Peaks in collaboration with 
facility staff and activity coordinators. Research staff will attend each site prior to the beginning 
of classes to explain the study, answer questions, obtain informed consent, and administer 
baseline assessments. Recruitment will continue as needed prior to the start of intervention 
sessions. 
 
Outcomes 
The primary outcomes of interest include changes in depression symptoms, anxiety symptoms, 
perceived stress, and chronic physical pain from pre- to post-intervention. 
 
Institutional Review Board 
All study activities, including participant recruitment, consent procedures, survey administration, 
and interviews, have been approved by the Northern Arizona University Institutional Review 
Board under protocol # 2185298-9. 
 
 

Analysis Plan 
 
Mixed-Methods Framework 
This study uses a convergent mixed methods design, in which quantitative and qualitative data 
are collected in parallel, analyzed separately, and then integrated at the interpretation phase to 
produce a more complete understanding of the intervention’s impact. The convergent approach 
allows for direct comparison of findings across methods and supports triangulation to strengthen 
validity. Figure 1 demonstrates a visual representation of the mixed methods procedures. 
 
Figure 1. Convergent Mixed Methods Framework 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Quantitative Measures 
We will collect data using an electronic survey to assess depression symptoms, chronic pain 
symptoms, stress, and isolation. The Patient Health Questionnaire-2 (PHQ-2)5 will be used to 
assess for depressed mood and lack of pleasure over the past two weeks. The General Anxiety 
Disorder-5 (GAD-5)6 will be used as an initial screening for anxiety symptoms. The Von Korff 
Chronic Pain Scale7 will be used to identify the degree and intensity of pain. The Perceived Stress 
Scale (PSS)8 will be used to assess the perception of stress and the degree to which certain life 
events are perceived as stressful. These will be quantitatively assessed using a dose-response 
framework. When considering the effects of the MBI, the number of MBI sessions will correspond 
to a higher “dose.” Dose-response curves will be compared between individuals with high 
attendance and active participation and low attendance and passive participation. Statistical tests, 
including paired t-tests and dose-response curves, will illuminate differences in index scores pre- 
and post-MBI. Further, the dose-response model will estimate the average number of sessions 
necessary to elicit a statistically significant change in the above measures. Analyses will be 
conducted using STATA18 statistical software.  
 
Qualitative Measures 
Thematic analysis will be used to identify emerging themes and patterns from 10 semi-structured 
interviews conducted by a research team member once the 6-week sessions are complete. We 
will conduct interviews with participants and/or participants’ caretakers (if the participant is not 
able to engage in an interview), group facilitators, and musicians. Analysis will occur over iterative 
stages involving systematic coding and comparative methods in an interactive, inductive process. 
ATLAS.ti Windows will be used to organize and store the data for analysis of themes. Qualitative 
instruments are included in Appendix C. 
 
Anticipated Results 
We expect increases in the use of music for managing physical and mental symptoms and 
decreases in anxiety, depression, stress, and pain. Improvements are anticipated to correlate with 
both overall attendance and active session participation. The integrated analysis will explore how 
these effects vary by level of engagement and experiences of mental and physical disability. This 
model enables estimation of both intervention efficacy and mechanisms of change. 
 
 
 
 

References 
 
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https://www.nami.org/NAMI/media/NAMI-
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