The Social Organization of Post-Secondary Music Students’ Work and Health: An Institutional Ethnography Protocol

Abstract

Researchers have found that many post-secondary music students suffer from physical and mental health issues. However, researchers have mainly studied these problems at the individual level, with little investigation of how music students’ work is shaped by the coordinating effects of policies, texts, and discourses at and beyond their local site. This paper describes a protocol for an international project that will explore the health of music students in the context of their daily work. Using an institutional ethnography approach, we will examine the social organization of music students’ work at three universities: two in Canada and one in Australia. This will be the first set of studies that use institutional ethnography specifically for the purpose of understanding how the social organization of music students’ work shapes their health. Data will be collected using several methods common to institutional ethnography: interviews, focus groups, observations, and collecting texts. Data analysis will begin during the data collection process and proceed in two fluid stages. The first stage will involve a detailed investigation of the pertinent work activities at each music school. The second will involve linking that work to specific social relations within and beyond the institution. After data analysis has been completed at all three sites, findings will be compared to one another to identify commonalities and differences in how students’ work is organized. Findings of the entire project may inform policy-making and lead to positive change at the institutions studied, as well as others where similar social organization may occur. The novel approach described here will provide opportunities to expand current knowledge about music students’ work and health beyond what has been learned through approaches that focus on students’ individual behaviours and attributes.

Background

Health issues among post-secondary music students are alarmingly commonplace. Multiple studies have found music students’ physical and mental health to be worse than that of the general student population (e.g., Ballenberger et al., 2018; Christian Bernhard, 2007; Gilbert, 2021; Kok et al., 2015). Typical concerns include musculoskeletal conditions, hearing problems, and mental health difficulties. International studies have found the lifetime prevalence of playing-related pain problems among music students to be as high as 89% (Ioannau & Altenmuller, 2015), with a recent European multi-site study conducted across 56 higher education music institutions finding that 65% of students had experienced musculoskeletal pain during the preceding 12 months (Cruder et al., 2020). Other studies suggest that the hearing of up to a third of music students is affected by tinnitus (Olson et al., 2016), and over half experience moderate to severe anxiety and/or depression (Payne et al., 2020).

To address the concerns surrounding music students’ health, a number of health education interventions have been implemented and evaluated for their effectiveness. These range from shorter term interventions, such as a five-day mindfulness course (Diaz et al., 2020), or a combination of two workshops and a masterclass in performance psychology (Osborne et al., 2014), to two-semester-long courses in body awareness and injury prevention (Árnason et al., 2018) and musicians’ physical and psychological health (Matei et al., 2018; Zander et al., 2010).

Many of these courses have had positive outcomes for music students’ health. For courses that included a physical health promotion component, positive outcomes typically included increased body-awareness (Árnason et al., 2018; Czajkowski et al., 2022; Lee et al., 2012; Martín López & Faríaz Martínez, 2020) and a reduction in pain for those experiencing pain at the start of the course (Détári & Nilssen, 2022; Spahn et al., 2001). Positive outcomes for courses with a mental health promotion component included a reduction in music performance anxiety (Osborne et al., 2014; Stern et al., 2012), improvements in coping with music performance anxiety (Spahn et al., 2016; Steyn et al., 2016), and lower levels of anxiety (Kim, 2005; Stern et al., 2012).

Still, some studies have noted mixed outcomes of participation in health courses (Baadjou et al., 2021; Matei et al., 2018; Spahn et al., 2017; Zander et al., 2010). Matei et al. (2018) found that although self-efficacy and knowledge increased following the course, so did levels of distress and depression. They note, however, that this may have been influenced by the end of the course coinciding with the end of semester, which is typically a busy and stressful time for students. Zander et al. (2010) found that while their course helped reduce psychological symptoms among undergraduate music students, it did not succeed in reducing physical health symptoms. An important concern that has been raised by Baadjou et al. (2021) and Wijsman and Ackermann (2019) is that in spite of increased health awareness, musicians’ uptake of health advice and behaviour changes following participation in a health education course can be low.

Music students’ health has primarily been considered a personal responsibility and influenced by factors such as their personality traits, health awareness, and access to health education courses. Broadening inquiry into the ways in which students’ work and health interact with their educational environment has been supported by Perkins et al. (2017) and Jääskeläinen et al. (2020). Both groups of authors found that the competitive music school environment and heavy workload were among the challenges music students experienced in looking after their health. Similarly, Rosabal-Coto’s (2016) study analyzing postcolonial music education in Costa Rica found connections between the social organization of one post-secondary music school and students’ health. However, no research has been conducted specifically to investigate how music students’ work is coordinated by dominant discourses, institutional policies, and practices that shape their health in ways that may be reflected in the high prevalence rates found in the literature. A deeper investigation of these aspects of post-secondary music education could provide key insights into music students’ work and health that have not been found solely by examining students’ individual behaviours and attributes.

This paper describes a protocol for an international project that will address these gaps using the approach of institutional ethnography (IE). Although IE protocols have been published for studies in the fields of education (Kearney et al., 2018) and health care (Webster et al., 2015), this is the first published IE protocol for a study on music education and musicians’ health. This paper will outline the approach to inquiry, research design, plan for analysis, and roles of various team members across the entire project.

Although IE protocols have been published for studies in the fields of education (Kearney et al., 2018) and health care (Webster et al., 2015), this is the first published IE protocol for a study on music education and musicians’ health. This paper will outline the approach to inquiry, research design, plan for analysis, and roles of various team members across the entire project.

Approach to Inquiry: Institutional Ethnography

Institutional ethnography (IE) is a feminist sociological research approach that Canadian sociologist Dorothy Smith began developing in the 1970s (Smith, 1987). The roots of the approach lie in Smith’s observation that the sociology of her time was far removed from ordinary people’s experiences of the world (Smith, 1987). Institutional ethnography sets out to explore problems that people encounter in their everyday lives and aims to generate research findings that are of use for the people whose issues are studied (Rankin, 2017b).

Institutional ethnographers take the viewpoint that the everyday world is fundamentally social (Campbell & Gregor, 2004). In other words, researchers consider embodied individuals as actively participating in social relations, which in turn shape the work of those individuals (McCoy, 2021). IE defines work broadly, as everyday activities that are intentionally done and that take time and effort (Smith, 2005). In contemporary societies, work activities are typically mediated by texts (e.g. policies, regulations), which can extend beyond space and time to regulate practices across local contexts (Turner, 2006). Smith refers to these forms of social organization as ‘ruling relations’ (DeVault, 2007). Given this ontological position, problematic social outcomes are considered to arise from the ruling relations’ coordination of work. This becomes the focus of inquiry in institutional ethnography.

Institutional ethnographers take the epistemological position that all knowledge is situated, whether or not this is made explicit in how research is conducted and written up (Cupit et al., 2021). An IE study seeks to gather knowledge from a particular position within the relations of ruling, which is made explicit and called a ‘standpoint’ (Smith, 1997). As this study considers music students’ health, it takes the standpoint of music students.

Research Design

IE research often focuses on a “problematic”: “something troubling” (Campbell & Gregor, 2004, p. 47) or “some sense of unease” (Campbell & Gregor, 2004, p. 47) in the experiences of those located at the standpoint. Though the formulation of a preliminary problematic and set of research questions is useful in giving the research direction, ultimately, the problematic of an institutional ethnography will only be discovered in the process of undertaking the research (Rankin, 2017a). Based on existing research literature, as well as the researchers’ lived experiences, a preliminary focus or problematic for this study has been identified: a large proportion of music students experience physical and mental health issues, which stall their musical development and bear potentially serious consequences for their lives in and beyond music.

Research Setting

This international study will be conducted at three universities: two in Canada and one in Australia. All three universities offer several undergraduate music degree programs at a music school or department. These range in size from a student body of about 150 to over 800. These universities have been selected as study sites because each of them offers some form of health education for students enrolled in a degree program at their music schools. This, along with the diversity of program size and geopolitical context, will enable important new insights to be gained about how health education is organized and happens in the broader context of a music school.

Research Objective

This study will examine music students’ health in the context of their day-to-day activities, with the aim of understanding how students’ work and health are shaped by the coordinating effects of institutional policies, texts, and discourses, and how these ruling relations may enter into the local site via their activation by students and staff.

Research Questions

1. How is the work of music students socially organized at each of the three study sites?

2. How does the social organization of music students’ work relate to their health?

Participants and Recruitment

This study will begin from the standpoint of music students at each of the partner universities. Both students and staff members will be recruited as participants. Recruitment will be ongoing and purposeful. Students enrolled in the music program will be recruited first, followed by faculty and staff members who work in the music program or have a role in policy or administration that influences the work of music students. The specific recruitment methods will be adapted to each setting and may involve methods such as using posters or verbally introducing the research during classes attended by music students.

Explicit recommendations for numbers of participants are not generally given in institutional ethnography literature (Bisaillon & Rankin, 2013). Instead, participant recruitment is guided by “features of experience, diversity, and social location” (Bisaillon & Rankin, 2013, para 12) and the ways in which these contribute to researchers’ understanding of the ruling relations under consideration. Consequently, numbers of standpoint and other informants in IE studies conducted at higher education settings vary. Some have included anywhere from one (Ranero, 2011) to 49 standpoint informants (Majee, 2019) and two (Rodriguez, 2020) to 41 other informants (Majee, 2019).

In line with these numbers, researchers will aim to recruit 20–25 student standpoint informants and approximately ten other informants per site. Because institutional ethnography studies are iterative, these numbers may be adjusted at each site based on the data collected there. For example, if sufficient understanding of the institutional processes under study is gained before the target number of interviews, interviews may be stopped earlier. Alternatively, if it is found that insufficient understanding has been gained after conducting the target number of interviews, more interviews may be scheduled. Further, if the recruited participants do not reflect the diversity of students at the institutions studied (e.g., in involving anyone from historically marginalized groups), efforts may be made to include more participants from these groups.

Data Collection Methods

Institutional ethnography research is iterative and therefore not fully planned out in advance (Rankin, 2017b). Although IE studies use data collection methods common among other forms of qualitative research, what is distinctive is what is being searched for: the relations of ruling that coordinate everyday experiences and practices (Peacock, 2014). Data collection typically starts with the lived experiences of standpoint informants – in this case, the music students – so researchers can learn about their everyday work (Smith & Griffith, 2022). Then, the direction of research is determined progressively by the information students share. Further data collection will be undertaken with other informants (e.g., instructors or administrators) as needed. Researchers will observe activities that are identified as significant in students’ everyday work. Texts that are central in shaping students’ everyday activities will also be collected and analyzed.

Interviews and Focus Groups as Data Collection

Interviews and focus groups will be conducted with students and/or staff members. Interviews will be semi-structured and last approximately 1 hr. Focus groups will include open-ended questions to encourage group discussion and last approximately 2 hr. Each group will contain about seven to ten participants, as recommended in focus group literature (Krueger, 1988). When talking to students, researchers will aim to develop an understanding of their work activities and how these interact with their health. With staff, discussions will concern their own work, with a particular interest in activities that bring them in direct or indirect contact with students. Insights gained from each interview or focus group will inform the questions used in future sessions.

Throughout the study, researchers will pay particular attention to mentions of people, places, discourses, and texts, as these may suggest avenues for further exploration (Campbell & Gregor, 2004). Where descriptions of work remain vague or use professional language, researchers will ask for additional details to more clearly understand how work unfolds in practice (Bisaillon, 2012). These data collection methods will help guide the direction of inquiry at the beginning of the study at each site. They may also be used after observations and text collection (see below) to further clarify relevant work processes and activities.

Observations as Data Collection

Observations will complement interviews and focus groups as needed, attending particularly to questions of voice, space and body positionings, and power as it is exercised in the moment. Observations will help researchers understand how work unfolds in practice within a particular context. Researchers may notice how observed activities relate to verbal descriptions of that work provided during interviews or focus groups (Campbell & Gregor, 2004). Observations may also help researchers locate central texts and watch how they are used in specific activities (Balcom et al., 2021). The specific activities observed will vary at each site and may include those carried out by large or small groups. Large group activities (carried out by ten or more members) may include academic or performance classes, ensemble rehearsals, administrative meetings, or public performances. Smaller group activities may include one-to-one music lessons or small group rehearsals, workshops, or other non-curricular activities. Field notes will be written throughout observations to document empirical data.

Texts as Data Collection

As researchers proceed with interviews, focus groups, and observations, they will also identify and collect texts for analysis. In institutional ethnography, texts are material objects that carry messages to “coordinate what people do across multiple sites and times” (Smith & Griffith, 2022, p. 50). Because IE is iterative, it is difficult to specify at the outset what specific texts will be relevant to the ruling relations under study. Relevant texts will likely include both administrative texts (e.g., policies, curricula, program requirements, etc.), as well as those involved in music performance and education (e.g., musical scores, repertoire lists, pedagogical materials, etc.). The goal of collecting texts will be to understand how they are used to organize the everyday work of music students.

Plan for Data Analysis

Data analysis in institutional ethnography starts from the early stages of data collection and proceeds iteratively (Rankin, 2017b). The aim of IE analysis is to map a set of social relations from a particular standpoint (in this case, music students in a post-secondary institution) to understand how people’s work is socially organized by those relations (Dalmer, 2020). To do this, analysis proceeds in two stages. In our study, the first stage will involve a detailed investigation of the pertinent work activities at each music school. As researchers gather data in the manner described above, they will examine that data for descriptions of people, places, discourses, and texts that are relevant to students’ work and health. This will help them determine with whom to speak, what activities to observe, and which texts to collect. This ongoing, iterative process of collecting and analyzing data will reveal “what is happening on the ground” (Kearney et al., 2018), which can then be linked to the broader social organization (McCoy, 2006).

The second stage of analysis will be to “explicate” how student health issues extend beyond the individual and link to specific social relations (Campbell & Gregor, 2004). IE defines institutions broadly, as sets of relations “organized around specific ruling functions” (DeVault & McCoy, 2006, p. 17). Therefore, the social relations relevant to this study may include the processes used to govern the music school, as well as wider discourses that organize the work of music students and staff. Different IE analysis techniques may be used to link people’s work to these wider processes, and researchers will choose these techniques to suit the data collected at each site (Rankin, 2017b). In doing so, researchers will bring into focus implicit features of the social organization of students’ work to generate new knowledge about the settings being studied (Bisaillon, 2012).

Analysis at each site will primarily be carried out by the doctoral or postdoctoral researcher at that site in conjunction with their supervisor. Other team members may be consulted about data analysis as needed (e.g., team members with extensive experience with IE). IE researchers are encouraged to make analytical choices that suit the particular needs of their study as IE analysis is not meant to be comprehensive, but rather to map specific ruling relations that are relevant to the lives of standpoint informants (Cupit et al., 2021). Any disagreements about the direction of data analysis will be discussed among team members to determine a suitable solution by consensus. While specific disagreements cannot be anticipated in advance, such decisions will be guided by the study aims (listed above), the data collected, and the ontological foundations of IE. The latter will be understood by referencing key IE methodological texts (e.g., Smith & Griffith, 2022) and consulting experts both inside and outside the team.

After data analysis has been completed at all three sites, findings will be examined in relation to one another. Researchers may identify commonalities among the sites, including how similar social relations may “reach across arenas” to organize music students’ health in related ways (Devault, 2007, p. 296). They may also identify differences that reflect unique organizational aspects of individual settings. As in many institutional ethnographic studies, the overall goal of analysis will be to develop findings that are useful for people at the standpoint (Smith & Griffith, 2022). Ideally, these may be used to inform policy-making and lead to positive change at the institutions studied, as well as informing policy-making at other institutions where similar social relations may occur.

Timeline

Australian Site

At the Australian site, data collection started in March 2023 and is expected to continue until the end of 2023. Analysis began during the process of data collection and will conclude in 2024. Findings of the research will be presented in the dissertation of the doctoral student at the site, Mona Oikarinen, in 2025.

First Canadian Site

Data collection at the first Canadian site will take place between January and April of 2024. Analysis of that data will begin during data collection. Findings of the research will be presented in the dissertation of the doctoral student at the site, Jeffrey Sabo, in 2026.

Second Canadian Site

A postdoctoral researcher, Dr. Kyle Zavitz, will collect data at the second Canadian site. Data collection at the second Canadian site will begin in January, 2024. Analysis of that data will begin during data collection. Findings of the research will be presented by Dr. Zavitz at that site in 2024.

Ethics

Ethics approval has been granted for the project as a whole by the Research Ethics Board (REB) at the university of the overall project’s principal investigator (Dr. Christine Guptill). Ethics approval has also been received at each of the three institutions being studied. The main ethical issues for the study relate to emotional distress, consent, and confidentiality. The researchers anticipate that the risk of emotional distress for participants in the research is low, as the emphasis in interviews and focus groups is on everyday activities. However, participants may speak about their own health challenges or difficult interactions they have had with others. Therefore, all participants will be advised that they can choose not to answer a question or to exit an interview or focus group at any point. In the event that a participant indicates that they are experiencing a high level of distress, they will be encouraged to seek help from a health professional. The primary researcher at each site has undertaken training on recognizing, responding, and referring someone in a mental health crisis to health services and will be equipped with a list of resources identified by each institution to support students (e.g., crisis hotlines, university counselling services).

Because this study involves recruiting participants with many different roles in the respective universities, it is essential that potential participants are able to provide their consent to participate without fear of personal, academic, or professional repercussions. Precautions will be taken to ensure that potential participants do not feel unduly pressured to participate. To help ensure this, recruitment will be carried out primarily by doctoral and postdoctoral researchers at each site. Students or staff members may be invited to inform their peers of the study, but staff members will have no role in recruiting students. Similarly, staff members will have no role in recruiting other staff members who are under their supervision. Members of the research team who are employed at the university being studied will not engage in any recruitment activities nor be informed about the identities of participants who are recruited. In participant information forms, participants will be made aware that the study is being conducted separately from their program of study and that it has no relationship to student assessment or staff evaluation at any of the sites.

Given that participants will discuss their study- and work-related activities, steps will be taken to maintain their confidentiality. No data with identifying information will be stored at the university site where it has been collected. Instead, all raw data will be stored on a secure, password-protected cloud server at the principal investigator’s university, which is not a study site. Moreover, no identifiable participant data will be shared with team members who are employees of the university where it has been collected. Data will be de-identified before it is shared across or outside the research team, and each participant will be given a pseudonym. When study results are reported, participants will only be identified using their pseudonym or a generic title (e.g., an “administrator” or “professor”). Unfortunately, total confidentiality will not be possible in focus groups because participants will speak in front of other focus group participants. To enhance confidentiality of data collected in focus groups, participants will sign a confidentiality statement as part of their consent to participate.

Rigor

IE departs from traditional qualitative methodologies in its understanding of rigor. Rather than judging rigor by its ability to “[ascertain] a representative sample,” rigor in IE is found through “employing the [methodological] techniques in ways that explicate ruling relations” (Walby, 2007, p. 1013). At the heart of this study is revealing how ruling relations enter into peoples’ everyday work activities, often through the use of texts. Rankin (2017a) suggests that rigor in IE comes from recognizing “generalizing relations” (Smith, 2005, p. 39), which link together discourses and practices across contexts. In this way, rigor will be established through attention to both the connections among chains of work activity by study participants in each site, and how “translocal” discourses and ideologies are implicated in organizing these sequences of work (Smith & Griffith, 2022). Moreover, rigor in IE is established through the multiple use of data sources, the length of engagement at each site, and participant feedback (Foo et al., 2021). All three research sites feature prolonged engagement, with data collection lasting over a period of at least a term (or semester). Researchers will also use multiple collection methods, which include regular interaction with participants who can provide feedback. Before the final writing and mapping of work sequences, researchers will again engage participants to share their research to ascertain a basic agreement with the flow of participants’ work and note any disagreements or concerns. Researchers at each site will also regularly meet with supervisors and other team members (including methodological experts in IE) to ensure that each study is carried out in a rigorous manner.

Conclusion

Post-secondary music students have been found to experience high rates of physical and mental health issues in many studies over the past several decades (Baadjou et al., 2016; Barros et al., 2022). To address these long-standing problems, researchers have called for greater institutional responsibility in post-secondary music education (Chesky et al., 2006). However, relatively little research has investigated how students’ lives and health are actually organized by institutional processes. Without this knowledge, it is difficult to identify specific changes that will meaningfully impact students’ health. This protocol outlines a study that will use Institutional Ethnography (IE) (Smith & Griffith, 2022) to examine the social organization of music students’ work and health at three sites. Data will be collected at each site using interviews, focus groups, observations, and text collection (Rankin, 2017a). Analysis will begin during the early stages of data collection, with the aim of producing both a description of local work activities and explication of how these link to wider ruling relations (Campbell & Gregor, 2004). Because IE is exploratory and iterative, the exact findings of this project cannot be predicted in advance (Rankin, 2017b). That being said, IE has rarely been used in music education, and it has never been used to directly investigate questions surrounding music students’ health. The novel approach described here will provide opportunities to expand current knowledge about music students’ work and health beyond what has been learned through approaches that focus on students’ individual behaviours and attributes. Once the project is complete, the knowledge gained can be used to inform institutional change in ways that have direct relevance to students’ lives and can hopefully lead to better health outcomes. It may also provide impetus for more research of this kind to be carried out in the future.