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Development and progression of group cohesiveness in a singing programme for people with post stroke aphasia: an evaluation study using video analysis

Background: As well as difficulties in language function, many people with post stroke aphasia report problems with psychosocial health, including reduced social participation and social isolation, and lower levels of wellbeing – health outcomes exacerbated by low levels of confidence and self-efficacy in social situations (Cruice, Worrall, & Hickson, 2006; Dalemans, DeWitte, Beurskens, Van Den Heuvel, &Wade, 2010). The Singing for People with Aphasia (SPA) study is a pilot randomised controlled trial of a new group-based singing programme aimed at improving these health outcomes. Instilling a strong sense of group cohesiveness is a core component of this programme’s logic model (Tarrant, Warmoth, Code et al., 2016), building on previous research that has established the benefits of group membership and social identity for health (Haslam, Jetten, Postmes, & Haslam, 2009) Aim: In the current contribution, we report findings from an investigation of the group dynamics that emerged across the singing programme with a specific focus on group cohesiveness. Methods and Procedures: SPA is a 10-week programme comprising weekly group singing sessions of 90-min each, led by a community musician, and supported by a music champion who has aphasia. Inclusion criteria included: diagnosis of aphasia after a stroke, capacity to consent, conversational English (pre-stroke); Exclusion criteria included: <18 years of age, current involvement in speech and language programme, participation in another study involving a lifestyle intervention, or participation in another singing group. Family, friends, and carers are welcome to participate in the sessions. Three singing groups are running in Devon, UK, as part of the trial (target N = 48). We report here on one completed singing programme (N = 7 participants). Sessions 1–9 of the programme were video recorded (approximately 13.5 h total recording time), and each recording was split into 10-min segments (8–9 segments per session; 80 segments). Segments were randomised for analysis. Outcomes and Results: A trained independent rater coded each segment using the Harvard Community Health Group Cohesiveness Scale (GCS) (Budman, Demby, Feldstein et al., 1987). The GCS contains six items, measuring participant interest and involvement, within-group trust, cooperation, expressed caring, focus, and global cohesion. Ratings were made on 11-point scales (−5 to +5, with scores below zero representing a lack of