The use of music as an arts-based method in migrant health research: a scoping review protocol

There is increasing recognition that people’s lived experience needs to be incorporated into health decision-making. This has led to rising imperatives for involving the public in health processes, including research. While there have been significant advances in the field, patterns of exclusion still exist in some areas, including migrant participation in health research. Migration and mobility create challenges around social inclusion and this extends to social and cultural practices used in research. There is an emerging body of literature about improving meaningful, participatory spaces for migrants’ involvement in health research using creative tools and techniques that are attuned to cultural diversity. These include the use of arts-based research methods. There is strong evidence for the use of music, particularly singing, as an effective arts-based participatory tool . The goal of this scoping review is to investigate the evidence for the use of music as an arts-based method in migrant health research. Developed by an interdisciplinary team specialising in public and patient involvement; nursing and midwifery; primary health care; and the performing arts, it aims to analyse existing evidence across disciplines that are not usually studied together, identify gaps in current knowledge and use these as a foundation to build effective strategies towards increasing access to and knowledge of participatory, arts-based methods using music in migrant health research. Methods: The protocol for this scoping review follows the guidelines and stages set out in the JBI Reviewer’s Manual ( Peters et al., 2017), and by Levac et al, (2010), which build on the methodological framework of Arksey and O’Malley (2005). This incorporates six stages: 1) Identifying the research question; 2) Identifying relevant studies; 3) Study selection; 4) Charting the data; 5) Collating, summarising, and reporting results; and 6) Consultation.


Introduction
There are rising imperatives for involving the public in health decision-making. The rationale comes from several sources (Gibson et al., 2012) but includes an increasing recognition that people have lived experience of health and, thus, are experts whose experiential knowledge needs to be incorporated into analysis to ensure a comprehensive epistemic baseline (Popay & Williams, 2006). This patient and public knowledge has a key role to play in the promotion of good health; (Ascenso et al., 2018;Brown et al., 2018;Jones et al., 2013;Roberts et al., 2017;Tarr et al., 2014) prevention of ill health; (Chabot et al., 2019;Conceição et al., 2016;Fancourt & Perkins, 2018a) managing and treating illness; (Cao et al., 2016;Gopalkrishnan 2016;Wan et al., 2010) the development of health services and strategy (WHO Europe, 2002;WHO, 2018) as well as health research (HRB Strategy 2016Horizon 2020;Ramsden et al., 2010;Wallerstein et al., 2018), which is the focus of this article.
There have been significant advances in the field of involving the public in health research. In spite of challenges with conceptualisation (Sarrami-Foroushami et al. 2014), there is an acknowledged need for expanding the evidence base around meaningful, rather than tokenistic, involvement drawing on a variety of research traditions and methods (Chew-Graham, 2015). There are specific areas that require further development including patterns of exclusion whereby migrant's involvement in health decisionmaking is rare (de Freitas & Martin, 2015;MacFarlane, 2019). However, there are complexities in accessing and understanding this experience. 'Migrants' are a heterogenous group of peoples. There is no agreed universal definition for a 'migrant'. The broadest one, from the International Organisation for Migration is 'anyone who has moved from their habitual residence (within or across borders)'. The term 'migrant' can refer to students, family reunification, labour migrants (moving to higher/lower paid employment), people seeking protection, people who are trafficked and so on. Further still, migrants' identities and experiences are not only defined by this issue of 'movement' but, also, by gender, ethnicity, class and culture. Intersectionality captures this complexity (Crenshaw, 1995). Finally, migrants have different health experiences but also share health experiences with the people in the communities in which they settled. While there are specific health implications of pre-migration and migration journeys (trauma, screening), migrants have non-communicable diseases and considerable health needs in relation to these, just like host populations (WHO Europe, 2018).
There is a view that these patterns of exclusion exist because migrants are hard to reach or easy to ignore (Lightbody, 2017). This view focuses on challenges in access and communication and concerns about the additional work and resources that health researchers would need to involve migrants. Certainly, there are issues to consider. These include cross-cultural interactions between migrants and health researchers (O' Reilly-De Brún et al., 2018); concerns for migrants about safely interacting with academia/officialdom (van den Muijsenbergh et al., 2016); and problems with representation of power, particularly given the heterogeneity of migrant experiences (De Freitas et al., 2014;Vaughn et al., 2017).
Given the ethical imperatives for migrants' involvement and the anticipated benefits for a more comprehensive knowledge base, which incorporates their expertise, a key question is how best to involve migrants in health research and, further, what is the evidence of best practice in terms of ethics, ontology and methodology? Migration and mobility create inevitable challenges around social inclusion and this extends to social and cultural practices used in research (Rubina et al., 2010). Therefore, in order to optimise migrants' involvement in health research we need to think creatively and innovatively about effective strategies to enable and ensure meaningful participation. Participatory Health Research is a paradigm which centralises participation from the outset to the completion and dissemination of research. It emphasises shared governance and community ownership (Wright, 2015). There is a rich tradition of participatory approaches that provide valuable tools, practices and techniques that have relevance for this endeavour (MacFarlane, 2019).
Despite the numerous publications on the role of music in health and well-being, it is striking that an examination of reviews to date on the use of arts-based methods in health identify very few studies using music as an arts-based research method. The inclusion of artistic practices as methodological tools in research is frequently labelled arts-based research (ABR). A useful definition of ABR is provided by Leavy as, "a set of methodological tools used by qualitative researchers across the disciplines during all phases of social research, including data collection, analysis, interpretation and representation … arts-based practices draw on literary writing, music, performance, dance, visual art, film and other mediums" (Leavy, 2009, p.ix).
The systematic review of arts-based methods in health research by Fraser & al Sayah, (2011) identified 30 articles using a variety of arts-based methods including photography (11), drawing (10), theatre (7) and poetry (2) but none of the studies specifically mentioned music. Boydell et al. (2016) identified 71 papers in their scoping review of arts-based health research using photography (23), theatre (21), drawing (8), film (8), poetry (3) and dance (1). Though eight studies used a variety of artistic practices, none of them mentioned music specifically. Coemans & Hannes, (2017) identified photography, theatre and poetry as the most often used artistic practices in ABR. Thus, while it is clear that music is being used as a tool of participation in health contexts, its role as a research tool is less well defined. A number of reasons may be suggested for this apparent anomaly.
Firstly, much of the research on the role of music in health and well-being is observational. For example, in the review carried out by Fraser and al Sayah, 30 articles were identified as using ABR but 56 were excluded as they did not use the artistic practice as part of the research method (Fraser & al Sayah, 2011). Such research observes and reports on the impact of music in health and well-being contexts, but does not use the arts as a research tool. In the case of music, the music practice becomes an object of study, rather than an intrinsic part of the research design, implementation or interpretation. Participation may be an important element of the observed practice, but not necessarily an aspect of the research method.
Secondly, there is a lack of consensus concerning the terminology used to describe research through the arts. The term arts-based research was first coined in the early 1990's by Elliot Eisner (Eisner, 2008;Barone & Eisner, 2012) and while it has steadily grown in usage since that time, there is still a great deal of research through the arts (including research in areas such as music therapy, community music and music education) which does not use this terminology. This is especially the case in health research, which has adopted the use of ABR terminology more slowly than, for example, creative arts practices, education, community-based research (Ledger & McCaffrey, 2015). The growing area of practice as research (PaR), also variously known as arts practice research, artistic research, arts practice research and practicebased research, further complicates the terrain (Nelson, 2013;Smith & Dean, 2009). Debates regarding nuances of meaning have resulted in a plethora of terms which often confuse rather than clarify the discourse (Chilton, 2013).
Another important factor includes understandings of what constitutes health research. The WHO definitions of health (Fancourt & Finn, 2019, p.2) and art (ibid, p.1) note that health is inclusive of individual, social and cultural wellbeing and that artistic practices also extend across individual, social and cultural spaces. Blacking's definition of music as 'humanly organised sound' (1973, p.10) was a direct response to narrower, ethnocentric definitions based on Western European aesthetics. These inclusive definitions challenge researchers to look beyond traditionally recognised health literature and disciplines to include health research carried out through music but published in areas such as ethnomusicology, cultural and social anthropology or community arts among others.
Finally, as Coemans and Hannes note, ABR is sometimes applied quite narrowly within the research design: "traditionally, ABR methods have been applied either as a data collection technique or as a dissemination technique" (2017, p.35). However, in ABR approaches, "the arts play a primary role in any or all of the steps of the research method" (Austin & Forinash, 2005, p.458-459) in order to exploit "the capacities of expressive form to capture qualities of life that impact what we know and how we live" (Barone & Eisner, 2012, p.5). A narrow application of the term often describes a process whereby artistic participation starts at the point of data generation or collection, but music is also used very successfully as a tool for initiating and creating partnerships for research. Research frameworks or reviews which do not utilise an explicitly articulated participatory approach often fail to capture or identify this music-based research as ABR.
For these reasons, a scoping review conducted by an interdisciplinary team which focuses specifically on the use of music as an arts-based method is both necessary and challenging. In order to develop optimal modes of participatory research using music as an arts-based method to inform the field of migrant health research, we need to analyse existing evidence across disciplines that are not usually studied together by health researchers, identify gaps in current knowledge and use these as a foundation to build effective strategies towards increasing access to and knowledge of participatory, arts-based methods using music in migrant health research. These approaches should apply our knowledge of music as a participatory strategy and adapt it for the purposes of research so that it is ethically guided to yield knowledge that cannot be accessed, analysed or represented through standard research frameworks and modes of communication (Barone & Eisner, 2012). In addition, it is important to document the capacity of music to facilitate participatory spaces for building trust, raising participant voices in their own words and ways, and triggering empathy and understanding that leads to action (Bartleet et al., 2010;Bartleet & Higgins, 2018;Bonshor, 2018;Higgins et al., 2010). This is very much in line with the aforementioned principles of PHR (Wright, 2015).
The purpose of the scoping review The goal of this scoping review, therefore, is to investigate the evidence for the use of music as an arts-based method in migrant health research to advance knowledge about tools and techniques for participatory health research projects with migrants. In doing so, we have identified the following key objectives: • Ascertain the extent of current publications using music in migrant health research and identifying itself as ABR.
• Identify the research stages (participating, generating data, analysing, interpreting, disseminating) in which music features as an ABR method or part thereof.
• Identify whether particular musical practices are used more than others as part of the research design and implementation.
• Identify the key strengths and challenges discussed in the literature around the use of music as a research tool in migrant health research.
• Identify gaps in current knowledge and use these as a foundation to build effective strategies towards increasing access to and knowledge of participatory, arts-based methods using music in migrant health research Table 1 presents the definitions and boundaries that will guide how we utilise key concepts in our scoping review.

Methods
Due to the broad nature of the research question and objectives, we want to specifically capture the extent of the literature that utilises music as an ABR method in migrant health research in order to identify its evidence base. We aim to identify if and how music is being utilised as an ABR method in the field of migrant health research. With that in mind, a scoping review was identified as the most suitable methodology to help clarify key concepts and understand the extent of the evidence across disciplines around the use of music as an ABR tool in migrant health research. It is envisaged that a scoping review conducted in a systematic way can assist practitioners and policy makers in the area of migrant health research. To ensure rigour in our approach, the protocol for this scoping review follows the guidelines and stages set out in the JBI Reviewer's Manual (Peters et al., 2017),  Table 1. Concepts, definitions and boundaries. Concepts, definitions and boundaries for undertaking a scoping review to investigate the use of music as an arts-based method in migrant health research.

Arts-based research
Arts-based research is "a set of methodological tools used by qualitative researchers across the disciplines during all phases of social research, including data collection, analysis, interpretation and representation … arts-based practices draw on literary writing, music, performance, dance, visual art, film and other mediums" (Leavy, 2009, p.ix).
Barone & Eisner (2012) define arts-based research as 'an approach to research that exploits the capacities of expressive form to capture qualities of life that impact what we know and how we live' (p.5).
Any research approach that integrates music in the research design, and self identifies as arts-based research is included. Observational research where music (as an intervention, activity or participatory practice) is the object of study but not part of the research method used to harness and extend knowledge of human experience is excluded.

Music
Blacking (1973) states "Music is a product of the behaviour of human groups, whether formal or informal: it is humanly organised sound. And, although different societies tend to have different ideas about what they regard as music, all definitions are based on some consensus of opinion about the principles on which the sounds of music should be organised." Studies that focus on human music-making are included. Studies that focus on music-making by nonhumans are excluded.

Migrants
A broad definition of a migrant, as used by the International Organisation for Migration, is "anyone who has moved from their habitual residence (within or across borders)" Studies that include migrants are included. Studies that focus on community populations without any representation of migrants are excluded.
Health WHO (1948) defines health holistically as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity", thus rooting health firmly within society and culture.
Studies that focus on physical, or mental or social well-being are included. Studies that are not focused on health are excluded.

5)
Collating, summarising, and reporting results; and 6) Consultation. This protocol will outline how we will address each of the six stages.

Stage 1: Identifying the research question
In order to clearly identify the research question guiding the scope of the review, we iteratively searched and designed our key search terms to capture the most appropriate body of literature. In formulating our research question, we identified four key concepts that encompass the interdisciplinary nature of the scoping review. These are: ABR, music, health, and migrants. The principal contextual settings within which these concepts will be explored are: music as an ABR method, and migrant health. Our key objective is to use the literature to investigate if and how music of any genre (including singing, choirs, musical performance, solo music, ensemble music etc.) is being utilised as an ABR method in these contexts. The conceptualisation of novel or innovative approaches to health research and the utilisation of music as, or as a component of, an ABR method in research involving migrants is the focus of our enquiry. This led to the formulation of our research question: "What is the evidence for music as an arts-based method and its use in migrant health research?" We can also refine the list as part of the iterative nature of our review process, and report on this process in the results paper. The bibliographical references of included papers and reviews on the topic will be checked for eligible articles that did not appear in the search. Deliberation among all members of the research team regarding exclusion and inclusion criteria at the outset of the scoping review process will occur. Table 2 provides an overview of the eligibility criteria for the scoping review.

Stage 3: Search strategy and study selection
In line with Arksey & O'Malley's (2005) framework, we will clearly define the terminology we intend to use within our search strategy in order to identify the most appropriate body of literature relevant to our research question. As noted by Levac et al. (2010), designing our search strategy has been an iterative process prioritising teamwork, interdisciplinary knowledge sharing, discussions and joint decisions around the definitions, concepts, and terminology involved. In order to test the appropriateness of selected databases and keywords, we are Table 2. Eligibility criteria. An overview of the eligibility criteria for the scoping review.

Population and sample
Human migrant Any study population other than humans

Language
Written in English Any other language that is not in English

Reviewers only speak English
Time period 2009 to 2020 Any publications outside these dates The publication of Leavy's 2009 definition is the basis of our review

Study focus Articles that discuss music as a participatory arts-based research method in migrant health
Articles that do not selfidentify as arts-based research and utilise music as an arts-based method in migrant health To build an evidence base for music as an arts-based method in migrant health research

Type of article
Peer reviewed journal articles, or peer reviewed books and chapters, or reviews and grey literature. Specifically, grey literature will include theses/dissertations, reports, conference proceedings, and editorials.
Any other literature that is not listed in the inclusion criteria, such as websites.
Scoping reviews aim to capture a comprehensive body of literature in order to expansively explore a broad research question. Preliminary searches of electronic databases and grey literature generally revealed papers reflecting our inclusion criteria Acknowledging feasibility and time constraints, we considered that the criteria listed would sufficiently capture the necessary literature to inform our review.

Study location
Any location -an international context. None Arts-based research has applications globally conducting preliminary searches in Taylor & Francis Online and CINAHL, searching article titles, abstracts, keywords and subject headings relating to our four key concepts: ABR, music, migrants and health. A comprehensive set of keywords will be used in the various databases encompassing the broad fields of arts, social science and health. If additional relevant keywords are identified, we will include these in our searches across all databases. Our search strategy will be further developed in collaboration with one of our faculty librarians.
Two independent reviewers will initially screen studies by title and abstract, and will subsequently conduct full-text reviews based on the pre-specified inclusion/exclusion criteria relevant to our research question. The two reviewers will meet at multiple stages of the review process to discuss any challenges, uncertainties or necessary refinements to the search strategy (Levac et al., 2010). If disagreements arise regarding inclusion or exclusion of studies, and cannot be resolved by consensus, a third reviewer will make the final decision. All eligible studies will be managed using Mendeley reference manager. Table 3 provides an overview of search terms.

Stage 4: Preliminary charting elements and associated questions
Following guidelines from the JBI Reviewer's Manual, a tabular chart organised in Excel (see Table 4) will be used for data extraction. This is comprised of JBI recommended charting elements and associated questions to guide the charting process. Charting elements about interventions are not included as these are not the focus of the present review. The table also includes review specific rows that have been added to record how articles address core concepts of this review: ABR, music, migrants and health. These additional rows will support the next stage of the review process; collating, summarising, and reporting the results (identifying themes). The process of charting data will be iterative so that new data can be incorporated if it enhances charting and analysis for our review question. Table 4 provides a preliminary table of charting elements and associated questions for data.
Stage 5: Collating, summarising and reporting the results As recommended by the JBI Reviewer's Manual (Peters et al., 2017), a narrative summary mapping the findings from the extracted data will complement the tabulated results and describe how they relate to the review's key question and objectives. As suggested by Levac et al., (2010), we will engage in thematic construction, using qualitative descriptive methods to provide an overview of the breadth of the literature. Findings will be organised into thematic categories such as aims, methodological design, key findings, and gaps in the literature. We will consider the meaning of the results in terms of the broader implications for research, policy, and practice in the context of music as an arts-based method in migrant health research.

Stage 6: Consultation
As suggested by Levac et al., (2010), we will include consultation with stakeholders to add methodological rigour to this study. This scoping review represents the work of the PART-IM Table 3. Search terms.

Year of publication
What year was the study/document published?

Origin/country of origin
Where was the study/document conducted and/or published?

Publication type
What type of publication is this? (empirical study, book/book chapter or grey literature)

General study details
Aims/purpose What were the aims of the work reported in the study/document?

Methodological design
What methodological design was used for this study?

Study population and sample size (if applicable)
Who is the target population of the study (i.e. what migrant group(s) and how many (n) were included in the study?

Methods
What specific methods (e.g. qualitative, quantitative, combined methods) were used in this study?

Key findings that relate specifically to the concept of ABR using music in migrant health research
Is there a definition of ABR from the literature

How does the study define ABR?
What form(s) of music are employed?
What are the forms of music that are used in the study? Is music employed with other art forms? Who delivered the music component? Was the focus on physical/mental health? Was the focus on prevention, treatment, recovery, promotion?
Was there an evaluation of the use of music?
What methods were used to evaluate the use of music? Was it a process or retrospective evaluation? Was the evaluation positive/negative/mixed?

Limitations/quality Issues
Were there any reported limitations or quality issues? (not a critical appraisal) (Participatory and Arts-Based Methods Involving Migrants in Health Research) research cluster which is part of the Health Research Institute, Public and Patient Involvement capacity building theme at the University of Limerick. The research cluster brings together arts-based and participatory scholars from medicine, nursing & midwifery, and the performing arts, as well as a leading NGO for migrants. These stakeholders have expertise to inform our scoping review. They have been involved from the beginning in its planning, have commented on this protocol and will be invited to discuss preliminary findings, validate findings and inform ideas about future research.

Ethics and dissemination Ethics
Ethical approval is not required for this scoping review.

Dissemination
This study integrates collaborative knowledge-sharing through the involvement of key stakeholders in a process of discussion and consultation. In addition, findings will be disseminated through academic conferences and peer review publications focused on participatory arts-based health research in the context of national and international migrant health research and policy.

Study status
Database searches have been completed. Titles and abstracts have been screened and full texts are being assessed against the eligibility criteria.

Data availability
No data are associated with this article.