Facilitators and Barriers to Sustainment of a Community Choir Program to Promote Health Among Diverse Older Adults: A Multi-site Study.

This paper reports on the successful sustainment of community choirs for diverse older adults following completion of a cluster randomized trial of choir participation on health and well-being. Trial participants showed decreased loneliness and increased interest in life after 6 months. Following trial completion, we examined the facilitators of, and barriers to, choir sustainment at intrapersonal, interpersonal, and structural/organizational levels. We conducted focus groups with trial participants who continued during the sustainment period. We also interviewed the music professionals and administrators who delivered or supported the program. To further identify barriers, we interviewed trial participants who did not continue in the choirs. We used a mixed inductive-deductive approach for content analysis of the transcripts. On the intrapersonal level, facilitators included a sense of well-being and positive emotions, while barriers included significant health and access issues. On the interpersonal level, relationships and social interactions functioned as both facilitators and barriers, depending on circumstances. On the organizational/structural level, high-quality programs facilitated sustainment; transportation and funding created barriers to sustainment. Facilitators far outweighed barriers to sustainment. Consideration of key facilitators and barriers can provide insights into sustainment of community choirs designed for diverse older adults.