Empowering Sustainable Therapeutic Engagement with Music (ESTEEM): a Pilot Study of a Self-administered Music Therapy Program for Cardiac Rehabilitation Participants in Thailand

INTERVENTION: We aim to recruit 24 participants from Phase 2‐3 cardiac rehabilitation program. Consenting participants will participate in the Empowering Sustainable Therapeutic Engagement with Music (ESTEEM) program for 8 weeks at the hospital cardiac rehabilitation unit. ESTEEM is a music therapy program that has been designed to enable people with CVDs in cardiac rehabilitation to develop capacity in self‐administering music interventions to address their psychological wellbeing in the long term. Music interventions in this program consist of multiple music experiences with an emphasis on recreative and receptive experiences. Sessions will be conducted for 2 hours once per week (for 8 weeks; 8 sessions in total). Each session will consist of approximately 6 participants and a Registered Music Therapist (RMT) who will be facilitating the session. Session structure: 1. Warm‐up, 2. Learning about music interventions for self‐administration, 3. Break: refreshments and social interaction, 4. Collaboratively tailoring the music interventions for each individual participant (i.e., the RMT will implement music therapy process and consider each participant s individual qualities such as music preference, preferred way to engage with music, musical background and relationship with music, preferred coping style, cultural background, etc.), 5. Experiencing the tailored music interventions, 6. Group discussion, reflection, and adjustment of the music interventions, 7. Wrap‐up, 8. Post‐session social interaction. The participants will be encouraged to self‐administer music independently in their daily lives whenever they need. The intervention manual/diary will be provided to the participants to review their music interventions and to CONDITION: Cardiovascular ‐ Coronary heart disease Cardiovascular ‐ Other cardiovascular diseases Depression in cardiac rehabilitation participants;Anxiety in cardiac rehabilitation participants;Stress in cardiac rehabilitation participants; ; Depression in cardiac rehabilitation participants ; Anxiety in cardiac rehabilitation participants ; Stress in cardiac rehabilitation participants Mental Health ‐ Anxiety Mental Health ‐ Depression INCLUSION CRITERIA: The participants will be recruited from the research site (i.e., a hospital cardiac rehabilitation unit in Bangkok, Thailand). The inclusion criteria are 1) adult participants in Phase 2‐3 of the cardiac rehabilitation program of the research site hospital, 2) clinically stable and showing evidence of expected physical recovery, 3) physically independent, 4) intact cognitive functioning, 5) functional visual/hearing with or without aids, 6) fluent in Thai, 7) able to conveniently travel to the hospital for sessions and data collection, 8) express interest in using music to promote psychological wellbeing and willing to participate throughout the course of the study, and 9) consent to participate in the study and able to make consent independently. PRIMARY OUTCOME: Anxiety: The Thai language version of the Depression, Anxiety and Stress Scale 21 (DASS‐21) (Lovibond & Lovibond, 1995; Oei et al., 2013).[Data collection will be conducted at (T0) baseline, (T1) week 4, and (T2 primary time point) week 8 after starting the program. The intervention group participants will attend a follow‐up assessment at 3 months after the program.] Depression: The Thai language version of the Depression, Anxiety and Stress Scale 21 (DASS‐21) (Lovibond & Lovibond, 1995; Oei et al., 2013).[Data collection will be conducted at (T0) baseline, (T1) week 4, and (T2 primary time point) week 8 after starting the program. The intervention group participants will attend a follow‐up assessment at 3 months after the program.] Feasibility: Data on the number of participants, adverse event, feedback, and/or challenge encountered will be recorded by the researcher during the sessions and collected from the participant's self‐reported diary.; ; Possible adverse events may include: ; 1. Psychological distress during the music therapy process.; 2, COVID‐19 and other contagious diseases at the research site (i.e., hospital).; 3. Physical accidents (e.g., fall, bump) when using music in daily life.; ; In case of any adverse event, the participants are encouraged to contact the research staff immediately. The diary also allows the participants to self‐report any distress or adverse event. [Throughout the course of the 8‐week study and at the 3‐month follow‐up.] SECONDARY OUTCOME: Participants' experience (Primary Outcome): Post‐study semi‐structured interviews will be conducted with the intervention group participants. The questions will explore participants’ experience throughout the course of the study including the experiences of participating in the sessions, self‐administering the music interventions, participating in the research process, and whether the participants were satisfied or had any suggestion for improvement. The participants' diaries will be collected for additional data on their experience. [Interviews will be conducted after the completion of the 8‐week ESTEEM program. Another interview will be conducted at the 3‐month follow‐up to see if the participants continue to engage with music in a long term and reflect any further experience of self‐administering music interventions during this timeframe. Diaries will be collected at week 8 and at 3‐month follow‐up.] Stress (Primary Outcome): The Thai language version of the Depression, Anxiety and Stress Scale 21 (DASS‐21) (Lovibond & Lovibond, 1995; Oei et al., 2013).[Data collection will be conducted at (T0) baseline, (T1) week 4, and (T2 primary time point) week 8 after starting the program. The intervention group participants will attend a follow‐up assessment at 3 months after the program.]