Matei, Raluca (2019) Better practice: health promotion in the music conser- vatoire. Doctoral thesis (PhD), Manchester Metropolitan University in collab- oration with The Royal Northern College of Music. Downloaded from: https://e-space.mmu.ac.uk/622806/ Usage rights: Creative Commons: Attribution-Noncommercial-No Deriva- tive Works 4.0 Please cite the published version https://e-space.mmu.ac.uk BETTER PRACTICE: HEALTH PROMOTION IN THE MUSIC CONSERVATOIRE Raluca Matei A thesis submitted in partial fulfilment of the requirements of Manchester Metropolitan University for the degree of Doctor of Philosophy ROYAL NORTHERN COLLEGE OF MUSIC AND MANCHESTER METROPOLITAN UNIVERSITY FEBRUARY 2019 Abstract This thesis addresses two main questions: 1) What can be learned from existing approaches to promoting musicians' health? 2) How can such approaches be adapted, applied and evaluated across educational and professional contexts in the UK and internationally? To answer the first question, literature reviews were conducted of interventions aimed at improving health education; preventing music performance anxiety (MPA) and performance-related musculoskeletal disorders (PRMDs); and conserving musicians’ hearing. A survey of European conservatoires was conducted to explore their provision of health education. A range of programmes was reported; they vary widely in focus, quality, and outcomes. Only 21 responses were received, so firm conclusions cannot be drawn, but guidelines on health education are clearly worth developing. A study of trends in students’ use of counselling at a UK music conservatoire showed year-on-year increases in sessions attended, primarily for issues related to self-esteem, relationships, academic concerns, loss, abuse and anxiety. To answer the second question, a compulsory health and wellbeing course for 103 first year students at the same conservatoire was designed on the basis of findings described above and in collaboration with members of Healthy Conservatoires. Pre-post testing showed improvements in the students’ perceived knowledge of health topics, awareness of risks to health, and self-efficacy; the students enjoyed the course and reported changes in both attitudes and behaviours. Finally, 111 music students at several UK conservatoires took part in a cross-sectional survey designed to investigate a range of potential risk factors for PRMDs. The results showed poor knowledge of official guidelines for physical activity (PA) despite high levels of self-reported PA; relatively high levels of anxiety; and reliance on teachers and lectures for health-related information. The thesis concludes with a discussion of its implications and suggestions for further research, including an example of relevant ongoing research on musicians’ health literacy. ii Publications and Presentations The publications and presentations below are based on material from this thesis. Peer-reviewed publications The following peer-reviewed papers can be found in the supplementary material section (pages 345 - 374). Matei, R., Broad, S. & Goldbart, J. & Ginsborg, J. (2018). Health education for musicians. Frontiers in Psychology, 9(1137). DOI: 10.3389/fpsyg.2018.01137 Matei, R. & Ginsborg, J. (2017). Music performance anxiety in classical musicians – what we know about what works. British Journal of Psychiatry International, 14(2), 33-35. Matei, R., Ross, S., Ginsborg, J., Broad, J. & Goldbart, J. (2015). Promoting health in music education: Better Practice. Proceedings of the Ninth Triennial Conference of the European Society for the Cognitive Sciences of Music, 574-583. Retrieved from: https://www.escom.org/proceedings/ESCOM9_Manchester_2015_A bstracts_Proceedings.pdf Peer-reviewed conference presentations Matei, R., & Ginsborg, J. (2018). Musicians’ health education: Programme design and evaluation. Paper presented at the European Society for the Cognitive Sciences of Music and the European Society for the Cognitive Sciences of Music (ICMPC15-ESCOM10) Conference, Graz, Austria. Matei, R., & Phillips, K. (2018). Where are we with musicians’ health and wellbeing? Workshop conducted at the Higher Education Academy (HEA) Annual Conference, Birmingham, UK. Matei, R. (2018). Between complacency and creativity – Bridging the gap through questions? Paper presented at the Art in Motion - Training for Creative Excellence Conference, Munich, Germany. iii Matei, R. (2018). Health education and the conservative conservatoire. Paper presented at the Study Day and Workshop on Music, Well- being and Mental Health, York, UK. Matei, R. (2018). A health education programme in undergraduate music training: Applying health psychology. Paper presented at the SCCH Consulting 2nd Practitioner Applied Health Psychology Conference, London, UK. Matei, R. (2018). Health education for music students: Course design and evaluation. Poster presented at the Health Psychology in Public Health Network (HPPHN) Annual Conference, Hertfordshire, UK. Matei, R. (2017). Health education for music students: Course design, implementation and evaluation. Paper and poster presented at the UK Society of Behavioural Medicine (UKSBM) Annual Scientific Meeting, Liverpool, UK. Matei, R. (2017). A health course for music students: Design, implementation and evaluation. Paper presented at the SysMus Conference, London, UK. Matei, R. (2017). Health psychology in under-explored tonalities: Musicians’ health and wellbeing. Paper presented at the DHP Annual Conference, Cardiff, UK. Matei, R., Broad, S., Goldbart, J., & Ginsborg, J. (2017). A health course for music students: Design, implementation and evaluation. Paper presented at the International Symposium on Performance Science (ISPS), Reykjavik, Iceland. Matei, R., & Ginsborg, J. (2017). What should health education among music students be about? Paper presented at the Association for Medical Humanities Conference, Keele, UK. Matei, R., Ginsborg, J., Norton, N., Francis, J., & Larsson, A. (2016). Health promotion among musicians: Opportunities for health psychology. iv Roundtable conducted at the European Health Psychology Society/British Psychological Society Division of Health Psychology (EHPS/DHP) Annual Conference, Aberdeen, UK. Matei, R., Ginsborg, J. Broad, J., & Goldbart, J. (2016). Is health promotion among musicians in line with the evidence? Literature review and future directions. Paper presented at the Performing Arts Medicine Association (PAMA) Annual Conference, New York, USA. Matei, R., & Ginsborg, J. (2016). Musical Impact: Health promotion among musicians. Workshop conducted at the International Festival of Public Health, Manchester, UK. Matei, R., & Ginsborg, J. (2015). Is health promotion among musicians in tune with the evidence? Literature review and future directions (‘Better Practice’). Paper presented at the SEMPRE Conference, Glasgow, UK. Matei, R. (2015). Health promotion among musicians ('Better Practice'). Poster presented at the BPS DHP Annual Conference, London, UK. Matei, R. (2015). Promoting health in music education: Better Practice. Poster presented at the Psychology Postgraduate Affairs Group (PsyPAG) Annual Conference, Glasgow, UK. v Acknowledgements This thesis would not have been possible without the support of so many people! My thanks go to… Jane Ginsborg, for I could not have possibly felt more supported during the last three and a half years! As a supervisor, she does not merely oversee things casually, from a distance – she gets involved and fights the battles alongside her students, with atypical frankness and intensity for which I deeply cherish her! I am most grateful for her allowing me the freedom that not only did I badly need, but which also enabled me to make mistakes and learn from them. I felt her trust throughout – it was forever nourishing and even analgesic at times! Juliet Goldbart and Stephen Broad who complete my supervisory team, for their ongoing support. The staff and students at RNCM, but most of all to Barbara Kelly for her openness and support; Rachel Ware and Tom Wise for their kindness and for constantly making my life as a PhD student easier; and Bryan Fox for his human warmth and for being key in facilitating one of my studies. My fellow PhD student, friend and collaborator, Keith Phillips, for his honesty and delightful sophistication. Also, my thanks for all the long, stimulating, in depth conversations about many things under the sun, which inspired many of our joint events and provided the fuel for our ongoing collaboration. The Arts and Humanities Research Council (AHRC) for generously funding my PhD research. The North West Consortium Doctoral Training Partnership (NWCDTP), Realab (and Rosalinda Quintieri), the Institute of Musical Research (IMR), the Royal Musical Association (RMA), and the British Psychological Society (BPS) for generous funding towards my many projects and events. My parents for their love and support even when they perceived what I was doing as complete madness. My superb close friend, Andreea Lungu, for the intense (even exasperating at times!) intellectual rigour with which she helps me sharpen my arguments. I’m especially grateful for her never omitting to make me question my dearest assumptions, with rare curiosity and depth. My sister, Delia Matei, for her sweet friendship and her help in editing! Adina Mornell for trusting me enough to allow me to say uncomfortable things in front of an audience gathered to attend her conference. Salvatore Mangiafico, a researcher who answered many of my queries on statistics via Researchgate,