Everyone Can Sing: Protocol for a non-randomized feasibility study of class choir as mental health promotion among primary school children (ages 5-10) in Denmark

BACKGROUND: There is an urgent need for feasible and effective mental health promoting interventions from early childhood. High-quality music education carries the potential to promote school thriving, positive class community, and social relations, which are key prerequisites for children's mental health. However, the implementation and potential benefits of this type of intervention have not yet been evaluated in the Nordic countries. The Everyone Can Sing intervention is a class-based singing intervention that integrates class choir into the regular school schedule, two lessons a week for primary school children in grades 0 to 3 (age 5-10 years). The lessons follow a manualised pedagogy, which combines co-teaching between the class teacher and an educated choir leader with enactive learning in a safe atmosphere, changing choir partners, musical arousal regulation, a song repertoire including movement and gestures, and choir performances in and outside school. The aim of this feasibility study is twofold: 1) To examine feasibility of the implementation of Everyone Can Sing in three Danish primary schools, and 2) to examine feasibility of the evaluation design.

METHODS: A non-randomized single-group feasibility trial will be conducted from January 2024 to March 2025 among approximately 900 primary school children in grades 0 to 3 in three Danish public primary schools. Six domains relating to feasibility of the intervention (barriers and facilitators of implementation, adaptability, implementation capacity, responsiveness, acceptability, and signs of benefit and harms) and three domains relating to feasibility of the study design (validity of questionnaire, uncertainties in data collection, and outcome measures) will be assessed. The study primarily employs a convergent mixed methods design, collecting quantitative data (baseline and follow-up questionnaires from students, parents, and teachers) and qualitative data (observations of choir and interviews with students, parents, teachers, choir leaders, Everyone Can Sing school coordinators, Everyone Can Sing management, and school management) in parallel. The design also incorporates elements of explanatory and exploratory sequential approaches. In the convergent phase, the two strands will be analyzed separately and then integrated through triangulation to assess both the feasibility of implementation and the feasibility of the evaluation design.

DISCUSSION: The results of this non-randomised feasibility study will inform whether the intervention should proceed to a future, full-size effectiveness trial, return to refinement of the intervention or the evaluation design, or stop. Trial registration ClinicalTrials.gov, ID: NCT06204029, registered January 2nd, 2024. https://clinicaltrials.gov/study/NCT06204029?cond=NCT06204029&rank=1.