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      Group‐based instrumental musical training to enhance resilience among school‐aged children from low‐income families: A pilot randomised waitlist controlled trial

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          Abstract

          Aim

          To evaluate the acceptability, feasibility and potential effectiveness of a group‐based instrumental musical training programme in improving resilience, depressive symptoms, self‐esteem and quality of life among school‐aged children from low‐income families.

          Design

          Assessor‐blinded pilot randomised waitlist controlled trial with process evaluation.

          Methods

          This study was conducted in the community from January 2022 to July 2023. Sixty‐four children from low‐income families (aged 8–12 years) were randomised (1:1) to intervention and waitlist control groups. The intervention group ( n = 32) received weekly 1‐hour instrumental musical training for 6 months in groups of four to five from professionally qualified musicians at a music centre. The participants in the waitlist control group ( n = 32) received the same intervention as the participants in the intervention group after the completion of all outcome assessments. The primary outcome was the children's levels of resilience, measured using the Resilience Scale for Children – 10. The secondary outcomes were depressive symptoms, self‐esteem and quality of life. Assessments were conducted at baseline (T0) and immediately post‐intervention (T1). An intention‐to‐treat analysis was performed.

          Results

          The 64 participants had a mean (SD) age of 9.5 (1.44) years, and 37 (57.8%) were boys. Compared with the waitlist control group, participants in the intervention group showed significantly greater improvements in resilience levels from baseline to T0 (group‐by‐time interaction coefficient β = 4.41; 95% CI, 1.82–6.99; p = 0.001), depressive symptoms ( β = −6.42; 95% CI, −11.12 to −1.71; p = 0.008), self‐esteem ( β = −2.60; 95% CI, 0.28–4.92; p = 0.028) and quality of life ( β = 6.69; 95% CI, 0.18–13.2; p = 0.044).

          Conclusion

          The group‐based instrumental musical training programme was feasible and acceptable for school‐aged underprivileged children and showed the potential to improve the resilience and quality of life of this vulnerable population.

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          Most cited references36

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          Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness.

          Qualitative content analysis as described in published literature shows conflicting opinions and unsolved issues regarding meaning and use of concepts, procedures and interpretation. This paper provides an overview of important concepts (manifest and latent content, unit of analysis, meaning unit, condensation, abstraction, content area, code, category and theme) related to qualitative content analysis; illustrates the use of concepts related to the research procedure; and proposes measures to achieve trustworthiness (credibility, dependability and transferability) throughout the steps of the research procedure. Interpretation in qualitative content analysis is discussed in light of Watzlawick et al.'s [Pragmatics of Human Communication. A Study of Interactional Patterns, Pathologies and Paradoxes. W.W. Norton & Company, New York, London] theory of communication.
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            Psychological Resilience

            The purpose of this paper is to review and critique the variety of definitions, concepts, and theories of psychological resilience. To this end, the narrative is divided into three main sections. The first considers how resilience has been defined in the psychology research literature. Despite the construct being operationalized in a variety of ways, most definitions are based around two core concepts: adversity and positive adaptation. A substantial body of evidence suggests that resilience is required in response to different adversities, ranging from ongoing daily hassles to major life events, and that positive adaptation must be conceptually appropriate to the adversity examined in terms of the domains assessed and the stringency of criteria used. The second section examines the conceptualization of resilience as either a trait or a process, and explores how it is distinct from a number of related terms. Resilience is conceptualized as the interactive influence of psychological characteristics within the context of the stress process. The final section reviews the theories of resilience and critically examines one theory in particular that is commonly cited in the resilience literature. Future theories in this area should take into account the multiple demands individuals encounter, the meta-cognitive and -emotive processes that affect the resilience-stress relationship, and the conceptual distinction between resilience and coping. The review concludes with implications for policy, practice, and research including the need to carefully manage individuals’ immediate environment, and to develop the protective and promotive factors that individuals can proactively use to build resilience.
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              Estimating the sample size for a pilot randomised trial to minimise the overall trial sample size for the external pilot and main trial for a continuous outcome variable

              Sample size justification is an important consideration when planning a clinical trial, not only for the main trial but also for any preliminary pilot trial. When the outcome is a continuous variable, the sample size calculation requires an accurate estimate of the standard deviation of the outcome measure. A pilot trial can be used to get an estimate of the standard deviation, which could then be used to anticipate what may be observed in the main trial. However, an important consideration is that pilot trials often estimate the standard deviation parameter imprecisely. This paper looks at how we can choose an external pilot trial sample size in order to minimise the sample size of the overall clinical trial programme, that is, the pilot and the main trial together. We produce a method of calculating the optimal solution to the required pilot trial sample size when the standardised effect size for the main trial is known. However, as it may not be possible to know the standardised effect size to be used prior to the pilot trial, approximate rules are also presented. For a main trial designed with 90% power and two-sided 5% significance, we recommend pilot trial sample sizes per treatment arm of 75, 25, 15 and 10 for standardised effect sizes that are extra small (≤0.1), small (0.2), medium (0.5) or large (0.8), respectively.
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                Author and article information

                Contributors
                ankiecheung@cuhk.edu.hk
                Journal
                Nurs Open
                Nurs Open
                10.1002/(ISSN)2054-1058
                NOP2
                Nursing Open
                John Wiley and Sons Inc. (Hoboken )
                2054-1058
                13 March 2024
                March 2024
                : 11
                : 3 ( doiID: 10.1002/nop2.v11.3 )
                : e2134
                Affiliations
                [ 1 ] The Nethersole School of Nursing, Faculty of Medicine The Chinese University of Hong Kong Hong Kong China
                [ 2 ] Department of Paediatrics and Adolescent Medicine, School of Clinical Medicine The University of Hong Kong Hong Kong China
                [ 3 ] School of Nursing The Hong Kong Polytechnic University Hong Kong China
                Author notes
                [*] [* ] Correspondence

                Ankie Tan Cheung, The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.

                Email: ankiecheung@ 123456cuhk.edu.hk

                Author information
                https://orcid.org/0000-0002-6498-0314
                https://orcid.org/0000-0002-0852-6299
                Article
                NOP22134 NOP-2024-Jan-0059.R1
                10.1002/nop2.2134
                10937816
                38481006
                2aab23ee-7419-4f51-b6f6-08d53882a404
                © 2024 The Authors. Nursing Open published by John Wiley & Sons Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 09 February 2024
                : 11 January 2024
                : 21 February 2024
                Page count
                Figures: 1, Tables: 5, Pages: 14, Words: 8464
                Funding
                Funded by: The Nethersole Institute of Continuing Holistic Health Education Research Grant
                Award ID: RG2021/2022_A_5
                Categories
                Discursive Paper
                Discursive Papers
                Custom metadata
                2.0
                March 2024
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.3.9 mode:remove_FC converted:14.03.2024

                children,depression,instrumental musical training,low‐income families,nursing,poverty,quality of life,resilience

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