title: Study protocol for a cluster randomized trial of the Community of Voices choir intervention to promote the health and well-being of diverse older adults.
abstract: BACKGROUND
  Older adults are the fastest growing segment of the United States population. There is an immediate need to identify novel, cost-effective community-based approaches that promote health and well-being for older adults, particularly those from diverse racial/ethnic and socioeconomic backgrounds. Because choral singing is multi-modal (requires cognitive, physical, and psychosocial engagement), it has the potential to improve health outcomes across several dimensions to help older adults remain active and independent. The purpose of this study is to examine the effect of a community choir program (Community of Voices) on health and well-being and to examine its costs and cost-effectiveness in a large sample of diverse, community-dwelling older adults.
  
  
  METHODS
  In this cluster randomized controlled trial, diverse adults age 60 and older were enrolled at Administration on Aging-supported senior centers and completed baseline assessments. The senior centers were randomly assigned to either start the choir immediately (intervention group) or wait 6 months to start (control). Community of Voices is a culturally tailored choir program delivered at the senior centers by professional music conductors that reflects three components of engagement (cognitive, physical, and psychosocial). We describe the nature of the study including the cluster randomized trial study design, sampling frame, sample size calculation, methods of recruitment and assessment, and primary and secondary outcomes.
  
  
  CONCLUSIONS
  The study involves conducting a randomized trial of an intervention as delivered in "real-world" settings. The choir program was designed using a novel translational approach that integrated evidence-based research on the benefits of singing for older adults, community best practices related to community choirs for older adults, and the perspective of the participating communities. The practicality and relatively low cost of the choir intervention means it can be incorporated into a variety of community settings and adapted to diverse cultures and languages. If successful, this program will be a practical and acceptable community-based approach for promoting health and well-being of older adults.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01869179 registered 9 January 2013.
authors.affiliation: Institute for Health & Aging, University of California, 3333 California St., Suite 340, San Francisco, CA, 94118, USA. Julene.johnson@ucsf.edu.|Center for Aging in Diverse Communities, University of California, San Francisco, USA. Julene.johnson@ucsf.edu.
authors.forename: Julene K
authors.initials: JK
authors.lastname: Johnson
authors.affiliation: Center for Aging in Diverse Communities, University of California, San Francisco, USA. anapoles@medicine.ucsf.edu.|Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, USA. anapoles@medicine.ucsf.edu.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Nápoles
authors.affiliation: Institute for Health & Aging, University of California, 3333 California St., Suite 340, San Francisco, CA, 94118, USA. anita.stewart@ucsf.edu.|Center for Aging in Diverse Communities, University of California, San Francisco, USA. anita.stewart@ucsf.edu.
authors.forename: Anita L
authors.initials: AL
authors.lastname: Stewart
authors.affiliation: Institute for Health & Aging, University of California, 3333 California St., Suite 340, San Francisco, CA, 94118, USA. Wendy.Max@ucsf.edu.
authors.forename: Wendy B
authors.initials: WB
authors.lastname: Max
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, USA. jasmine.santoyo-olsson@ucsf.edu.
authors.forename: Jasmine
authors.initials: J
authors.lastname: Santoyo-Olsson
authors.affiliation: Institute for Health & Aging, University of California, 3333 California St., Suite 340, San Francisco, CA, 94118, USA. Rachel.Freyre@ucsf.edu.
authors.forename: Rachel
authors.initials: R
authors.lastname: Freyre
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California, San Francisco, USA. theresa.allison@ucsf.edu.|Department of Family and Community Medicine, University of California, San Francisco, USA. theresa.allison@ucsf.edu.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Allison
authors.affiliation: Center for Aging in Diverse Communities, University of California, San Francisco, USA. Gregorich@medicine.ucsf.edu.|Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, USA. Gregorich@medicine.ucsf.edu.
authors.forename: Steven E
authors.initials: SE
authors.lastname: Gregorich
mesh_terms: D000368:Aged; D000375:Aging; D003362:Cost-Benefit Analysis; D005006:Ethnicity; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012107:Research Design; D012111:Residence Characteristics; D063346:Singing; D012959:Socioeconomic Factors; D014481:United States