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Abstract

The importance of social interaction and communication is emphasized in many types of musical care (e.g., music therapy, singing, or dancing group activities). It is surprising, therefore, that the interactional methodology Conversation Analysis (CA) is rarely found in musical care research. In this study, a scoping review was conducted to provide an overview of CA research in musical care settings. The review maps the contexts, types of participants, and disciplines within which CA research has been conducted. The findings and phenomena that have been investigated are explored through seven themes, and the contributions that CA can make to the varied field of musical care are discussed. In particular, the review highlights how CA as a methodology can provide new perspectives and important understanding of the ways in which music can support and facilitate communication and embodied interaction through providing participants with a resource to accomplish social actions, contribute more equally to interactions, be creative, display their identity, and create positive emotional connections with others. The article concludes with a recommendation that conversation analysis should be considered as a valuable tool for those conducting musical care research.

Keywords

Conversation analysis CA EMCA interaction music musical care scoping review

Introduction

Music is very often a communal, interactive experience. From parents with infants to children playing in the playground, and music festivals and football games to religious services and operas, music is often experienced with or alongside others. This is no different for settings of “musical care” – the wide range of contexts where musical activity (of some form) aims to improve or maintain physical or mental health, development, or other needs (Spiro et al., 2023). While individual music activities can certainly be musical care (e.g., mood regulation through music listening; Saarikallio & Erkkilä, 2007), more often than not social interaction and relationships with other people play a large part in the importance of musical care (Spiro et al., 2023). Indeed, interaction and/or some type of communication is often at least part of the aim of many care or therapeutic settings (e.g., between parent and infant, autistic child and peers, people with dementia and carers). A scoping review on music interventions for children and youth found that improving social skills was the most common therapeutic aim (Romano et al., 2024). Even when interaction is not an explicit aim of a study, it is an important element of the musical care setting (for example, interaction between a therapist or carer and their client; Spiro & Himberg, 2016, or social connections within group music activities; Dingle et al. 2021).

With this in mind, having a range of resources that are tailored to examining and analyzing interaction is vital to developing a fuller understanding of the role that music plays in musical care environments and its influence on the interactants. One such method that has been under-utilized is the interactionally-focused Conversation Analysis (CA). This review will aim to show some of the benefits of using CA for musical care research, and recommend that it be considered for future studies in musical care contexts where interaction plays a key role.

A Brief Introduction to Conversation Analysis

Conversation analysis (CA) is interested in “patterns of interaction” (ten Have, 2007, p. 120) within the structured social organization that allows everyday interaction to be meaningful, mutually understood, and coordinated (Goodwin & Heritage, 1990). It focuses on how participants within an interaction coordinate their talk, gesture, gaze, and other communication in an orderly way, and aims to understand how interaction is organized structurally and sequentially in order for it to be meaningful (Schegloff, 2007). It arose within the sociological discipline, mainly through work by Harvey Sacks, Emanuel Schegloff, and Gail Jefferson, with a large influence from ethnomethodology, such as work by Erving Goffman and Harold Garfinkel (ten Have, 2007). Previously, linguistic research into conversation tended to focus on content and used non-contextualized or hypothetical examples (Sidnell, 2010). CA, however, argues that “talk-in-interaction” is not just communication but how people achieve social actions and create a common social world (Drew & Heritage, 1992).

Schegloff (2007) describes six (inter-related) organizations of practice that ensure interaction progresses in an orderly way, which are used in CA research to explore interaction:

turn-taking organization – who will speak next, when, and how do people know when to switch speaker?

action-formation – what is a speaker trying to achieve, and how do the interactants understand it as that and respond accordingly?

sequence-organization – how are actions related to each other and organized to create a meaningful interaction?

repair – if something hinders the progression of the interaction (mishearing, misunderstanding, etc.), what happens? How is the issue resolved?

word-selection – how do interactants select the different aspects of their turn, and what is the effect of that on the ongoing interaction?

overall structural organization – how is the interaction organized at a broader level, and what is the effect of that on the understanding of the sequences and turns-at-talk within it?

The main principles of CA are that it (1) is close to the phenomena, using detailed microanalysis of transcripts of the phenomenon of interest rather than coding, counting, or otherwise summarizing occurrences; (2) uses naturally-occurring data, rather than artificially-created situations; (3) views interaction as organized and procedural – something that occurs between interactants emergently – and focuses on how it occurs, not why; and (4) studies how oral language is used, rather than “correct usage” as per other linguistic approaches (ten Have, 2007). Given the focus on talk being “orderly,” and the relevancy of immediate contexts, small datasets are the norm in CA (ten Have, 2007), with examples gradually built up across different settings (e.g., Heritage, 1988).

CA is an inductive, data-driven approach (Hoey & Kendrick, 2017), where researchers immerse themselves in the data by going back and forth between a video (or audio) recording and a detailed transcript, and looking in an “unmotivated” way for phenomena of interest (Sacks, 1985). They then create collections of examples of similar phenomena (e.g., places where singing is used within conversation), looking for patterns or sequences, without losing sight of the local context of each example. A CA research article would then highlight this pattern, providing extracts from the transcript as evidence and comparing places where the sequences are similar or different, to demonstrate a particular way that talk is organized by the participants within a certain context.

CA research also takes an emic stance (ten Have, 2007), in that arguments for the presence of particular actions or sequences should be understood from the view of the participants, not by the researcher looking in from outside the original interaction. For example, to argue that a particular utterance or embodied behavior is a directive (instruction), the researcher would need to demonstrate that another interactant treated it as such by complying (or accounting for why they had not).

CA research uses audio or (more recently) video recordings to capture natural interactions, which are then transcribed with a high level of detail. CA transcripts include relevant details such as overlaps, pauses, dysfluency, stresses, relative dynamic levels or prosody, laughs, and even breaths and tone (e.g., “smiley voice”). These are traditionally transcribed using the “Jefferson” conventions (Jefferson, 2004). Recent research investigating multi-modal communication has included a wider range of non-verbal behaviors, often using conventions developed by Mondada (2018). For the addition of musical elements (e.g., scores), other researchers have developed their own methods of conveying them alongside more traditional transcripts (e.g., Duffy et al., 2013; Emerson et al., 2019; Messner, 2024).

CA is relatively common in some disciplines, particularly sociology, linguistics, and education, but remains quite unknown in others. CA research has investigated interactions with people with communication difficulties (e.g., aphasia, learning difficulties) since the 1980s (e.g., Lubinski et al., 1980), becoming quite established by the mid-1990s and growing rapidly since then (Wilkinson et al., 2020a). There is also a sizeable body of research exploring interaction in medical fields, particularly between patients and healthcare professionals (e.g., Drew et al., 2001). It is surprising, then, that there has been very little attention paid to CA in musical care fields (e.g., music therapy, community music sessions, parent–infant singing, etc.), despite interaction being a clear focus in many research studies (e.g., Creighton, 2011; Engström et al., 2011; Spiro & Himberg, 2016). Indeed, over two decades ago, Sutton (2002) pointed out the potential usefulness of CA to music therapy, due to (improvised) music's similarity to conversation and the way that the approach embraces music as an interactional process, rather than an end product. Not every musical care context or research question would find relevance in CA, of course, but as an analytical perspective it could potentially yield valuable new insights to those where it is appropriate.

The Current Scoping Review

This article will conduct a scoping review of research in musical care settings that used conversation analysis, and review the studies found. Scoping reviews are used to create an overview of research in a particular area by synthesizing the available evidence. Similar to a systematic review in their process of gathering relevant research, the aim is to map out, describe, and summarize the nature, extent, and characteristics of the literature, looking for any patterns or gaps in the research (Flinkfeldt et al., 2022). They are often most useful in areas like the current review, where the available research is too heterogenous or insufficient for a full systematic review. With only a small number of studies, but a variety of participant types and phenomena, a scoping review was decided to be the most effective way of exploring the previous CA literature in musical care research.

In response to Spiro et al. (2023) and the Musical Care International Network's call for more interdisciplinary research methods to examine musical care (Musical Care International Network, n.d.), the aim of this review is to examine the usefulness of CA for exploring music in caring and therapeutic interactions. Specifically, it will consider which musical care settings and phenomena have been explored using CA and what this type of analysis can tell us about interaction within these contexts?

Method

Conversation Analytic Scoping Reviews

Only a small number of scoping reviews have been conducted using conversation analysis (CA) previously, such as Flinkfeldt et al. (2022), who explored CA research in social work, and Meyer et al. (2024), studying dietary health communication. This article follows the five steps for performing scoping reviews proposed by Arksey & O’Malley (2005) and refined by Levac et al. (2010): (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; and (5) collating, summarizing, and reporting results. However, given the specific nature of CA research, guidance was also taken from Parry and Land (2013), who provide specific guidelines for systematically reviewing and synthesizing CA research, and Ivaldi et al. (2021), who performed a systematic review on CA research within musical settings. It is noted throughout the following section where suggestions from these articles have been followed. It is worth observing that Parry and Land (2013) suggest that “off the shelf” (p.71) approaches to reviews are often not suitable for conversation analytic data, due to its differences from other types of qualitative data.

Eligibility Criteria

To be eligible for inclusion, articles had to meet six eligibility criteria (Table 1).

Table 1.

Eligibility criteria used in the scoping review.

1	Naturally-occurring data
2	Collected using video or audio recording
3	Published in English (although research where the original data was not English was included)
4	Published at any time (i.e., no time limit parameter, in line with Parry & Land, 2013)
5	Recorded directly from a setting where the phenomenon involved some form of musical care (see further detail below)
6	Uses conversation analysis, including detailed verbatim transcripts (see further detail below)

Setting the “musical care” parameter required careful thought and was an iterative process (Levac et al., 2010). “Musical care” has a broad definition: Spiro and Sanfilippo (2022) define it as “the role of music – music listening as well as music-making – in supporting any aspect of people's developmental or health needs” (pp. 2–3). Dance was also included due to its close links to music, and related therapeutic history (e.g., Sheppard & Broughton, 2020). However, “musical care” in the literature varied in relation to the research focus as well. There are, for example, a number of CA articles exploring music rehearsals and lessons, and although playing or singing can be beneficial, unless the focus of the research was care (e.g., a choir for people with dementia), these were not considered eligible. Similarly, or perhaps conversely, there were a few studies that explicitly used musical care settings (e.g., online dance classes for elderly people with dementia; Kosurko & Arminen, 2023) but where the musical element was given little to no attention within the research phenomenon or analysis in the study (e.g., how carers can encourage non-participating people). It was decided not to include these, as the research focus wasn’t deemed to be specifically musical. Additionally, three of the articles that were included discussed how people with dementia or a traumatic brain injury sang during conversations, even though conversation in itself is not necessarily a musical care context. However, since the outcome of the studies was a better understanding of how people with cognitive and/or communication difficulties utilize musical resources to interact with others – and better social interaction being an important element of musical care – the decision was made to include them.

In accordance with the main principles of CA described earlier in the introduction, to be included in the review studies needed to include detailed transcripts of naturally-occurring data within the phenomenon under study. In terms of the analysis, Parry and Land (2013) specify that it should be an inductive, detailed, “fine-grained analysis” (p.73) that is both interactional and with an explicit focus on the phenomenon of interest (communication in musical care settings). Because CA focuses on how interaction is organized sequentially, in context, studies that transcribed relevant data but analyzed through coding or categorizing were excluded. Comparable methods that arose, such as video microanalysis (e.g., Houghton & Beebe, 2016), were considered, since they generally included a detailed transcript of some form and careful (often sequential) analysis. However although there are similarities of the method itself (e.g., microanalysis of in-context data), researchers employed it in different ways, without necessarily referring to CA literature and within a variety of epistemological and empirical approaches, including interpretivist frameworks (Nielsen & Holck, 2020), with narrative descriptions (Vidal et al., 2018) and naturalistic inquiry, and structured observational coding (see Holck et al., 2004, for a description of three different approaches, for example). Therefore it was determined that “video microanalysis” could not be used as a synonym for CA. However, for interested researchers, articles that were “nearly eligible” can be found in the supplemental material, along with reasons for exclusion.

Search Strategy

The search strategy used included four search strings, relating to (1) methodology (CA, interaction, etc.); (2) musical (music, singing, etc.); (3) context (health, wellbeing, or care setting); and (4) type of data (video or audio). See Appendix A for the full search string.

The search process required several stages, following those suggested by Levac et al. (2010) with adaptations by Parry and Land (2013) – see Figure 1 for an overview. First, the search terms were entered into a variety of databases to attempt to cover the variety of disciplines under which relevant research might be published (e.g., healthcare, music, linguistics, psychology): APA PsycArticles, APA PsycInfo, MedLine, CINAHL, Cochrane database of systematic reviews, Web of Science and Scopus. A total of 6430 potential studies were found from the databases searched. In addition, as suggested by Arksey & O’Malley (2005), several key journals (with a music therapy, language, or arts and health focus) were hand-searched, as well as the bibliography section of the “Ethnomethodology/Conversation Analysis News” (EMCA) website. Forward citation searches were performed on relevant articles using the “Google Scholar” database, resulting in a further 1805 studies.

Figure 1.

Eligibility assessment process for the scoping review.

In total, 8235 citations found were downloaded into Mendeley, duplicates were removed, and title and abstract were used to review the studies using the inclusion criteria. Full texts were obtained for 273 studies deemed either relevant or unclear based on the abstract (usually due to methods being described only as “qualitative” or “video analysis”). These articles were then reviewed for eligibility, with a particular focus on research questions and methods sections. Where full texts were unavailable for shortlisted articles, other avenues were pursued to check the methodology and main findings (e.g., citations, other articles by the same author(s), systematic reviews).

A five-point scoring system was used to evaluate the studies using the eligibility criteria, from “not at all suitable” to “definitely suitable for inclusion.” Of the 273 full articles, 21 scored either 4 or 5 points and progressed to the extraction stage. A template based on Peters et al. (2015) with adaptations suggested by Parry and Land (2013) was used, extracting information about the aim, population, study context, methodology and data, phenomena and features analyzed, and conclusions and implications. In line with Flinkfeldt et al. (2022), quality assessment was not included, as it is not deemed to be as important for a scoping review as a systematic review. Through the extraction process, the parameters were fully determined in the final stages of the iterative process (Levac et al., 2010), for example, that video microanalysis would not be included, as discussed within the eligibility criteria. A final selection of eight studies were determined to meet all the criteria and be eligible for the scoping review.

Details on the 13 studies excluded at this stage, including reasons for exclusion, can be seen in the Supplemental Material. These may be of interest to researchers, as many of the settings are ones where CA would be equally useful in exploring the interaction. The articles explore ways of stimulating musical interaction between parents and autistic children (Chen, 2024), observing the impact of caregiver singing on dementia patients’ cooperation in caregiving activities (Götell et al., 2002), and understanding how turn-taking (Holck, 2004), synchronicity (Nielsen & Holck, 2020), and client–therapist connection (Houghton & Beebe, 2016) are (co-)created in music therapy sessions. There are also articles looking at different aspects of dance classes for people with dementia (Kosurko et al., 2021; Kosurko et al., 2023; Kosurko & Arminen, 2023; Nyström & Lauritzen, 2005), support interventions for people with dementia (Kindell et al., 2019; Samuelsson & Ekström, 2019), and singing in preschool children (Kultti, 2013; Rickert, 2022).

Finally, the findings of the eight eligible studies were collated and synthesized. Similar to Ivaldi et al.'s (2021) CA systematic review, an aggregative approach was utilized, using the practices demonstrated in the CA extracts to organize the findings thematically, as suggested by Parry and Land (2013). The aim was to draw together into themes some of the main findings across the studies, to provide a summary of the type of phenomena that have so far been found and explored.

Results

Following the guidance suggested by Arksey and O’Malley (2005) and Levac et al. (2010), this section of the scoping review starts with an overview of the basic characteristics and numerical summary of the eight studies to be included. An analysis of the findings then follows, summarizing seven main themes found across the studies, to help gain an understanding of the way that conversation analytic research can add to our understanding of musical care, and the phenomena that have thus far been investigated.

The number of studies that have used CA to examine musical care settings is surprisingly small, given the method's relative popularity in related fields such as speech and language therapy, and education. Table 2 below shows a summary of the eight eligible studies, in a condensed version of the extraction template utilized during the review stage.

Table 2.

Summary of characteristics of the eight studies included in the scoping review.

Authors	Year	Journal/source	Title	Aim/purpose	Study population and sample size	Context of data collection	Type of data (no. of hours)	Methodology	Phenomena and main features identified
Azios & Archer	2018	Journal of Aphasiology	Singing behavior in a client with traumatic brain injury: A conversation analysis investigation	“an exploration of a particular behaviour in a man with TBI, singing, to better understand the interactional environment, and goals associated with the behaviour.” (p. 944)	Tim – 23-year-old man with cognitive and speech deficits related to a traumatic brain injury (TBI) 8 years earlier Two graduate clinicians (Kay and Jane)	Conversations (non-therapeutic) during speech therapy sessions at a university clinic	Video data (10 sessions; 7 + hours)	CA, single case analysis	39 instances of singing during conversation - Normative use of singing (similar to singing in non-TBI) - As part of a topic nomination sequence - As a misalignment sequence - To close a sequence
Foster	2015	PhD thesis	Dementia and singing: A CA case study of singing in everyday interaction	“(1) how singing fits into the turn-taking structure of talk, (2) the emergent structure of a performance, and (3) what singing accomplishes in the moment.” (p. iii)	Dan – 80-year-old man Dan's wife (Morgan)	Singing in conversation at home	Video data (23.25 h)	CA single case study	38 occurrences of singing in conversation - Singing fits the sequential organization of the interaction, and isn’t random (unmodified singing to close sequences; modified singing as first/second pair parts, post-expansion). Treated as response to previous talk, and makes relevant responses - Songs emerge bit-by-bit, contingent on interactants’ responses - Singing as flexible, open-ended resource to accomplish different actions, both “main jobs” (e.g., complaining) and “off record” jobs e.g., managing decision rights - Singing as a way of resisting position of person with dementia (e.g., redirecting talk or topics that are challenging, positioning himself as witty)
Kindell, Wilkinson, Sage & Keady	2018	Journal of Arts and Health	Combining music and life story to enhance participation in family interaction in semantic dementia: A longitudinal study of one family's experience	“(i) to gain in-depth insight into the everyday experiences of family members around interaction; (ii) to use this knowledge to plan and deliver an individually tailored intervention to enhance interaction in the home situation; (iii) to explore the effects of the intervention on interaction and participation.” (p. 3)	Sarah – 64-year-old woman with semantic dementiaSarah's husband (Reg) and adult daughter (Harriet)	Prior to, and during the creation of a musical life-story DVD	Video data (127 min 49 s pre-intervention)Video (82 min) and audio data (122 min) of making DVD	CA, single case study (and narrative analysis)	“Three interactional practices: Distraction from Distress. Facilitating Interaction. In response to the lyrics. Making up own lyrics. Embodied and emotional connections. Performance and Identity. Embellishments and over-singing. Embodied performance. Reaction from her audience.” (p. 7)
Kosurko & Stevanovic	2023	Journal of Social Sciences	Beyond utterances: Embodied creativity and compliance in dance and dementia	How “creative action, which is inherent in artistic practice, emerges in and through participants’ variably compliant responses to directive instruction” (p. 305)	People living with dementia in 3 Canadian and 2 Finnish residential care institutionsOn-screen instructors and in person facilitators	Online chair dance classes for people with dementia	Video data (34 h)	Multimodal CA	Instances where participants comply with on-screen instructors or in person facilitators in compliant or creative ways - Compliance with multimodal directives, coordinated with musical tempo and rhythm - Music as a resource to organize turn-taking as participants orient to each other sequentially - Opportunities to improvise creative responses within compliance - Facilitator and participant cocreate their own dance within compliance, building on the other's moves and responding to affiliative stance displays
Kosurko & Webb	2024	Social Interaction. Video-based studies of human sociality	A touch of companionship: Supporting engagement in dance activities with people living with dementia	“to explore how the role of the companion emerges to engage PLWD [people living with dementia] in dance activities, with special attention on different uses of touch to support engagement in embodied interactions.” (p.1)	People living with dementia	Data from Skinner et al. (2018); Kosurko et al. (2020); Williams et al. (2023) - Canada, Finland, UK.Dance activities with PLWD and companions in institutional, long-term residential care (LTRC) settings	Video data.(34 h chair dance classes in Canada and Finland; 10 h various activities in UK)	Ethnomethodological conversation analysis (EMCA)	6 of 22 examples of caregivers supporting PLWD in dance activities using multimodal resources, especially touch. - Touch to engage joint attention (sleeping PLWD, wakes, looks at staff member then instructor, joins in) - Touch to connect to synchronous choreography - Assisting with a touch of summons and requests - Shepherding touch in trouble on the dance floor - Affiliating touch in engaged disaffiliation - Touch in turns to move together and move apart together (PLWD initiating touch with another to get them to join in)
Matérne, Plejert, Frank, Bui, Ridder & Warnicke	2023	Journal of Interactional Research in Communication Disorders	Interaction and multimodal expressions in a water-dance intervention for adults with intellectual and multiple disabilities	“The aim of this study is to describe and discuss how the SWAN program intervention leader, instructors, support persons, and participants with IMD co-operate, and how the interaction is facilitated during the intervention. A further aim is to identify expressions of emotion by the participants during the SWAN sessions.” (p.123)	3 adults with Intellectual and multiple disabilities (affecting movement, cognition, and spoken language)	SWAN - structured water-dance intervention - aquatic dance program for people with IMD, aimed at physiological, psychological and social aspects of health.	Video data.(12 sessions, 5 recorded, 3 analyzed in detail)	CA	Co-operation in interaction – encouragement, displays of comfort/safety/trust, joint orientation to new activities, dance interaction between participants Expressions of emotion – joint happiness between participant and carers, soothing anxiety, joy in response to recognized song, smile and vocalization in response to dance movement (shared positive expression with carers)
Rasmussen	2020	In Atypical Interaction: The impact of communicative impairments within everyday talk (Eds. Wilkinson et al., 2020b)	Singing as a resource in conversations involving persons with dementia	“The aim is to study what singing may be a response to and what it works to accomplish.” (pp.162–163)	Nancy – 90-year-old woman with fronto-temporal dementiaThe researcher (Rita)	Conversations between Nancy and the researcher	Video data, field notes (weekly visits for 9 months; two instances of singing)	CA, single case study	2 episodes of singing in conversation - Singing as a resource which allows someone with dementia to bring new perspectives to an atrophying topic of conversation - Singing linked to prior conversation through prosody, repeated words etc.) - Singing can achieve specific social actions and show different stances (disagreement; affiliation).
Roman	2023	Conference Proceedings of the 16^th International Conference of Students of Systematic Musicology (SysMus23)	Variation in the production of musical motifs as an interactional resource in music therapy: A conversation analysis	“explores how music can be used as an interactional resource to establish cooperative and coordinated interactions between participants, and sustain interactions through creating new opportunities for participants to respond within a music therapy interaction” (p.67)	Boy with disabilities Music therapist	music therapy session	Video data (2 min 34)	CA	Episodes establishing or sustaining interaction - musical motifs can be understood as invitations to respond, establishing cooperative and coordinated interaction - Variation in musical motifs occurred in response to interaction (e.g., changing tempo) and to create response opportunities for partner (e.g., extending motifs or introducing contrasting ones)

All eight studies were published within the last decade, ranging from 2015 to 2024. All of the studies came from different sources and from a variety of disciplines: journals in aphasiology, social sciences, arts and health, and two interactional journals. There was also a chapter from a book looking at communication in healthcare (Atypical Interaction, edited by Wilkinson et al., 2020b), a linguistics PhD thesis, and a proceedings article from a musicology conference (SysMus 2023). Originally, in line with most reviews, this scoping review was going to only include peer-reviewed works in the final list; however, given the small number of articles that were eligible for inclusion, it was decided that it was more helpful to include them, to give a more accurate overview of the research that is being done in the field. Scoping reviews do not usually evaluate the quality of the research in the same way as systematic reviews, but readers should be aware that lack of peer review removes even that usual precaution.

The data comes from a variety of countries: the UK (Kindell et al., 2018), Sweden (Matérne et al., 2023), Denmark (Rasmussen, 2020), the US (Azios & Archer, 2018; Foster, 2015), Finland (Roman, 2024), and both Finland and Canada (Kosurko & Stevanovic, 2023; Kosurko & Webb, 2024). All the data was video recorded. Participants with dementia were most common in the studies, although of varying types. Kindell et al. (2018) considered a 64-year-old woman with semantic dementia; Rasmussen (2020) conversed with a 90-year-old woman with fronto-temporal dementia; Foster (2015) considers an 80-year-old man with a diagnosis of “possible vascular dementia” (p.44) following a neurological event, and Kosurko and Stevanovic (2023) and Kosurko and Webb (2024) examine dance classes at long-term care facilities for people with dementia. The other three studies considered a participant with a traumatic brain injury (TBI; Azios & Archer, 2018), three adults with intellectual and multiple disabilities (IMD; Matérne et al., 2023), and a boy with disabilities (Roman, 2024).

In terms of context, the most common was a focus on the main participant singing during conversations: Azios and Archer (2018) with therapists during therapy sessions (NB. not music therapy, so the therapy itself was not the focus of the study), Foster (2015) during conversations between husband and wife at home, and Rasmussen (2020) during conversations with the researcher in a care facility. The other studies were set up with more explicit and obvious musical care aims: two exploring engagement during a seated dance class for people with dementia in residential care facilities (Kosurko & Stevanovic, 2023; Kosurko & Webb, 2024), one exploring a hydrotherapy dance intervention (Matérne et al., 2023), one recording conversations at home both before and during the making of a musical life-story DVD (Kindell et al., 2018), and one examining musical interaction during music therapy (Roman, 2024).

All of the studies used Jefferson (2004) as the basis for their transcription, with adaptations for multimodal (e.g., Mondada, 2018), embodied, or musical elements of interaction.

Phenomena Found in CA Musical Care Studies

Seven themes were developed through exploring the results of the studies: Music as a flexible resource; Embodied behavior with music; The power in music – balancing interactional roles; Accomplishing actions in talk-in-interaction; Demonstrating creativity in interaction; Using music in presentation of the self; and Creating positive emotions and emotional connections.

Theme 1 – Music as a Flexible Resource

One point that came through clearly from all the studies was the way that music could be used as a flexible, interactional resource or tool to aid the progression and development of different types of interaction. It could either be internal or external – participants could spontaneously use singing to progress conversational interaction of their own accord (Azios & Archer, 2018; Foster, 2015; Rasmussen, 2020), or the music might be provided by others within organized musical care settings, facilitating interaction (Kindell et al., 2018; Kosurko & Stevanovic, 2023; Kosurko and Webb, 2024; Matérne et al., 2023), or two participants might use music to create interactional opportunities for each other (Roman, 2024).

The flexibility of music (or dance) lies in how it can be utilized to perform a wide variety of actions, as discussed further in some of the other themes below. For example, music can progress or develop interaction by supporting turn-taking (Kosurko & Stevanovic, 2023), opening or closing topics of conversation (Azios & Archer, 2018; Foster, 2015), demonstrating stances such as affiliation (Foster, 2015; Rasmussen, 2020) or misalignment (Azios & Archer, 2018; Rasmussen, 2020), or directing and complying (Kosurko & Stevanovic, 2023). It is also individually adaptable in a way that allows participants to show their creativity (e.g., Kindell et al., 2018; Kosurko & Stevanovic, 2023) and use it to portray a particular self-image or identity (e.g., Azios & Archer, 2018; Foster, 2015; Kindell et al., 2018).

Music can also be used as a prompt, as Matérne et al. (2023) demonstrated when one participant recognizes the beginning of a song and begins the associated jumping exercise with pleasure. Music's predictability plays a role in this aspect, with the participant being able to know from a few bars which song is playing. In addition, the temporal predictability of the beat or rhythm allows participants to time their embodied movements to the music, such as jumping (Matérne et al., 2023) or actions/turns within a dance (Kosurko & Stevanovic, 2023).

Rasmussen (2020) refers to music as a compensatory resource – a way of repairing or compensating for issues with speaking or comprehending – but it is worth noting that this may not be the case for everyone. Foster (2015) observes that his participant doesn’t have speech or comprehension issues per se, but suggests rather that the music helps by freeing up cognitive resources and decreasing the cognitive load. Whatever its specific role in helping, music's function as a resource that can be used with or by participants is one of the elements that makes CA a particularly suitable methodology for exploring its role in talk-in-interaction. Roman (2024) suggests that CA, with its emic focus on understanding the interaction from the point of view of the interactants, is especially useful for resource-oriented approaches to interaction, as opposed to those that might focus on deficits.

Theme 2 – Embodied Behavior with Music

Another feature of note that appeared in a few of the studies was the embodied aspect of music. Embodied interaction is a frequent feature of CA research (e.g., Mondada, 2016), particularly within the performing arts (Ivaldi et al., 2021), and music lends itself easily to movement and actions (for example, dancing e.g., Keevallik, 2014; performing and teaching e.g., Tolins, 2013; or conducting e.g., Emerson et al., 2019). In the studies here, the embodied element is clear in the dance classes, where participants with dementia or intellectual and multiple disabilities comply with the instructor's movements and directives by participating or “bodily quoting” (Keevallik, 2010) in time with the music (Matérne et al., 2023), and indeed sometimes embellishing their movements (Kosurko & Stevanovic, 2023), or using touch to engage others (Kosurko & Webb, 2024). In others the embodied actions are more subtle – Foster (2015) discusses how a participant with dementia uses embodied practice to end a song jointly with his conversation partner; in Rasmussen (2020) the participant shows a possible embodied invitation to join in her singing through gaze, leaning forward, and smiling; and Kindell et al. (2018) looks at how music can facilitate and create both embodied connections with family members (such as reaching out to hold hands during an engagement song, despite no longer remembering the association) and embodied performances (such as holding out hands whilst singing as a performer might).

Theme 3 – the Power in Music – Balancing Interactional Roles

One feature that became clear in the analyses was that music often gave participants the opportunity to rebalance the scales within an interaction. Several studies showed or mentioned that during “normal” verbal conversation, participants would often take a more passive role, with their interactional partners doing much of the heavy work in progressing and maintaining the conversation. CA demonstrated how music allowed participants to contribute more equally to the interaction. For example, Azios & Archer (2018) and Foster (2015) both show how participants change the trajectories of a conversation to avoid highlighting their own disabilities or struggles, and Rasmussen's (2020) participant introduces new material to progress an atrophying topic of conversation. This is not necessarily unique to music, however – in one of the studies that was nearly included (see table in the Supplemental Material), by Samuelsson and Ekström (2019), women with dementia and their carers used tablet computers with applications containing pictures and videos as well as music to support their interactions (the study was not included because no music-based interactions were reported in the study). The authors found that the participants were more able to achieve topic transitions, accomplish initiatives, and maintain conversation compared to without the application.

Furthermore, Roman (2024) suggests that music allowed both participants to be able to create response opportunities for the other when playing music together, again, equalizing the interaction; the dance setting of Kosurko and Webb (2024) also allowed participants to initiate connections with others; and Kosurko and Stevanovic (2023) showed how music can facilitate turn-taking.

Theme 4 – Accomplishing Actions in Talk-in-Interaction

A common topic that came up – perhaps unsurprisingly, given CA's focus on how interaction is achieved – is that the music in each study facilitated interaction by accomplishing various actions in place of the (normally) verbal communication that might be used otherwise. Both Foster (2015) and Rasmussen (2020) pointed out that the singing was not random – it fitted into the sequences, had associative links to previous talk, maintained coherence within the interaction, and could accomplish a variety of actions through itself. Azios and Archer (2018) found that their participant could use music to nominate topics, close sequences, and show misalignment with his therapist's stance. Rasmussen (2020) similarly demonstrated the use of singing to show disagreement, as well as affiliation. Foster (2015) lists a number of actions achieved through his participant's singing – closing sequences, doing humor, appreciation, complimenting, complaining, and changing the trajectory of talk. In Kosurko and Stevanovic (2023), the music is used to facilitate complying with directives, creating a predictable organizing structure that lends itself to turn-taking and timing of adjacency-pair responses. Roman (2024) also shows how music was used by both client and therapist to offer participation opportunities, effectively organizing turn-taking within their playing. In summary, music is not a random addition to an interaction – it is a systematic, ordered, and organized resource that allows people who might otherwise struggle with communication to accomplish actions that progress the interaction effectively.

Theme 5 – Demonstrating Creativity in Interaction

In addition, participants are not just complying with directives or regurgitating lyrics that match a recent topic. The way that participants are using or working with the music is creative – Kindell et al. (2018) shows how their participant does not just sing, but performs, complete with embodied movements and vocal embellishments. Similarly, participants in Kosurko and Stevanovic's (2023) dance class do not just imitate the movements as directed but improvise their own moves to add to the dance. For example, one participant embellishes putting on a top hat with a dramatic flourish, and in a “coffee-pouring” dance, each participant receives and drinks their coffee in their own way, within the timing of the music, despite the facilitator's similar initiating actions to each. In this instance, the improvisation becomes co-creation with the facilitator and other participants, demonstrating moments of real creative connection within the interaction. In addition, Foster (2015) and Kindell et al. (2018) both show how their participants do not just quote songs but adapt them by changing lyrics to fit the ongoing interaction, demonstrating a musical flexibility and creativity that allows them to tailor the musical resource to the interaction and action they are aiming to achieve. Finally, one of the definitions of creativity is the ability to make connections between ideas (e.g., Styhre & Sundgren, 2003), so even the way that singing participants picked up on words, phrases, or ideas and connected them to songs that they know (Foster, 2015; Rasmussen, 2020) can be considered a form of creativity in itself.

Theme 6 – Using Music in Presentation of the Self

This theme focuses on how music gives the participants opportunities to create, construct, or present a particular identity or “self” in a way that they might find difficult to do otherwise. For example, Azios and Archer (2018) show how their participant with TBI uses music to redirect the conversation away from a line of questioning that is highlighting his disability and making it difficult for him to join in the interaction. Similarly, Foster's (2015) participant “positions himself as an active and engaged participant” (p. 12) through his singing, and as a humorous, clever performer, rather than a dementia patient. Like Azios and Archer's participant, he also uses music to direct his interactional partners away from topics to which he cannot contribute, which might show up his difficulties. Kindell et al. (2018) demonstrate how their musical life-story DVD allows a woman who otherwise struggles to contribute in a conversation to demonstrate her identity as a wife and mother (through showing affection in relation to particular songs), and as a singer and a performer (by joining in in a vocal and embodied way, including embellishing her performance). The authors note how the woman's daughter sees her as she used to be through these behaviors. Music therefore provides a means by which participants can present themselves how they would like to be seen, rather than as patients.

Theme 7 – Creating Positive Emotions and Emotional Connections

Although not a focus of many of the studies, it would be remiss not to discuss the emotional effects of music interaction. Kindell et al. (2018) discuss how the musical life-story distracts their participant from her distress – greatly lessening the number of times she requests medication for a headache, for example – and providing enjoyment (her husband reports six months later being surprised that the DVD has not worn out, given how often she has watched it). Matérne et al. (2023) also draws attention to the enjoyment shown by the participants in the SWAN water-dance class, highlighting one participant's delight when a favorite song/activity begins, for example. Several of the other studies do not go into as much detail, but mention smiling and laughing as part of the musical interaction.

In a related point, the music and musical activities provide opportunities for positive emotional connections. Kindell et al. (2018) discuss how the musical life-story allows the participant to connect with her husband and daughter through sung performances and song lyrics (and adapted lyrics), in a way that she struggles to do otherwise. Matérne et al. (2023) describe a moment in a circle dance where participants’ hands touch and they smile at each other, as well as moments of joint happiness between participants and their carers. Kosurko and Stevanovic (2023) discuss how participants and facilitators become co-creative together within their dance interaction, and Kosurko and Webb (2024), whose study focuses on how companions emerge through interaction, describe how “withness” develops between companions, such as one participant inviting another to dance.

Discussion

The aim of this scoping review was to give an overview of the conversation analytic research that has been conducted in musical care settings, looking in particular at which contexts and phenomena have been studied so far and what CA can tell us about interaction within those settings.

Following a systematic search, eight studies originating from a range of disciplines were found, of which five were from peer-reviewed journals (the others consisting of one book chapter, one PhD thesis, and one conference proceeding). All were published within the past decade. Older adults with dementia were the most common participants, alongside studies with an adult with traumatic brain injury, and younger adults and a child with disabilities. Dance classes (seated and in the water) and singing in conversations were the most common contexts examined, along with a study using music therapy sessions and one with a musical life-story DVD intervention.

The studies used CA to conduct detailed analyses of verbatim transcripts from musical care settings, focusing on sequential organization within the interactions and actions being accomplished. Thirteen additional studies (described briefly in the Methods section) were close to being included but were eventually excluded for not fully meeting the final eligibility criteria (e.g., using video-microanalysis but not CA, or a musical setting but without a musical care research focus). These studies are included in the Supplemental Material and may be of interest to researchers as a demonstration of potential research areas where CA could be used to explore further.

The small number of studies eligible for the review suggests that, despite CA being a relatively well-known and increasingly popular framework for studies in disciplines such as healthcare (particularly speech and language therapy, and communication between healthcare professionals and patients), education, and sociology, it is not a method that is familiar to researchers exploring musical care settings. Music therapy research, for example, has historically been predominantly quantitative (Brooks, 2003), although the number of qualitative studies is increasing (Aigen, 2008). The quantitative focus may be at least partially due to an emphasis on evidence-based practice, where randomized controlled trials (RCTs) in particular are seen as the “gold standard” for demonstrating efficacy (and therefore securing funding, etc.), influenced by music therapy's position within allied health (Edwards, 2015). However, Bradt (2012) advocates for the importance of a variety of evidence types and suggests that quantitative studies such as RCTs can run the risk of standardization, making them less relevant to real-life therapy situations. Of course, since CA research focuses on interaction specifically, not all musical care settings or research questions are suitable for its use. However, with its broad interactional evidence base, data-driven focus on local contexts, and increasing use in other areas of music research, CA provides a clear option for future research.

A review of the findings from the eight studies that were included suggested seven themes that come through: Music as a flexible resource; Embodied behavior with music; The power of music – balancing interactional roles; Accomplishing actions in talk-in-interaction; Demonstrating creativity in interaction; Using music in presentation of the self; and Creating positive emotions and emotional connections.

The themes show just how much can be seen through the use of CA, even with a small number of studies and participants, and demonstrate some examples of topics that CA is excellent at exploring. For example, they show how music and musical activities are used; how they can support and facilitate interaction and connections with others; and the power it gives people to participate, be creative, and construct a sense of self to display to the other interactants. The flexibility of music allows participants to “navigate challenging interactional ‘business’ without overly exposing cognitive deficit” (Foster, 2015, p. 12), and as such it is a powerful resource for people who struggle to interact and communicate verbally.

Some of the benefits of using CA as a methodology are clear from the studies reviewed here. For example, CA allows the researcher to systematically examine how the people in an interaction organize and make sense of it, with questions such as: What is the interactant accomplishing by doing that? How does their conversational partner interpret and respond to it? What is the effect on the interaction's progression? Answering these questions using CA allows the interactants’ meaning to come through, rather than the researcher attempting to interpret what is happening – particularly important for interactants for whom “normal” communication is trickier. This equal weighting of the importance of each participant in the interaction – looking at what they are accomplishing and what they are understanding in that moment – also fits well with the ethos of musical care research. Spiro et al. (2023) describe how members of the Musical Care International Network noted that musical care is a reciprocal activity, done “with” others rather than “to” them. Relatedly, Roman (2024) suggests that CA is particularly suitable for resource-focused research (rather than deficit-focused), with an emphasis is on what people can do, and how they do it, as demonstrated throughout the studies in this review.

A particular benefit of using CA in musical care settings is that some of the well-documented similarities between music and language (e.g., McMullen & Saffran, 2004; Temperley, 2022) extend to comparable elements between performing and conversation (e.g., Wigram & Elefant, 2009). This means that CA – with some adaptations – can be applied to many musical aspects of interaction as well as verbal ones in a very analogous way, such as turn-taking in music therapy (Holck, 2004), use of silence and pauses in improvisation (Sutton, 2023), nonlexical assessments and directives in music lessons (Tolins, 2013), and humming to manage issues within an interaction (Stevanovic, 2013). CA's ability to interpret interaction on a micro-level therefore lends itself very well to investigating how music facilitates interaction in, for example, conversation (Azios & Archer, 2018; Foster, 2015; Kindell et al., 2018; Rasmussen, 2020), dance (Kosurko & Stevanovic, 2023; Kosurko & Webb, 2024; Matérne et al., 2023), and music therapy (Roman, 2024). Both Azios and Archer (2018) and Foster (2015) point out that by examining a musical behavior that initially appears unusual within its sequential interactional context, CA can provide a fuller explanation for how and why it is being used: which social actions is it accomplishing? Analysis may demonstrate that it is serving an important interactional purpose, with consequences for how clinicians or families work with the behavior in question (such as whether or not to correct or change it).

The themes from this review give some suggestions of the value CA can provide to musical care research as a methodology, as well as future avenues for both researchers and practitioners. For example, some studies showed how participants used music to construct a particular identity for themselves (Foster, 2015; Kindell et al., 2018). Research on sense of self in, for example, people with dementia, is varied (Caddell & Clare, 2010), and CA could provide another important resource for understanding how identity can be retained, demonstrated, and supported. As another example, the micro-analytic level of CA in the studies also demonstrated the individual creativity that may be shown by people with communication or other difficulties, for example within organized arts activities (Kosurko & Stevanovic, 2023) or through the use of singing in conversation (for example by adapting lyrics, making connections to topics, or embellishing songs; e.g., Foster, 2015; Kindell et al., 2018; Rasmussen, 2020). Creativity has been linked to positive impacts on well-being (e.g., Acar et al., 2021), so exploration of this in populations where it may be difficult to use traditional activities or measures could provide valuable information.

Some of the studies reviewed focused on specific interventions (e.g., dancing, water-dance, musical life-stories), demonstrating how CA could provide an alternative (or additional) within-context way of evaluating or adapting interventions, compared to retrospective reports or measures, for example. Previous non-CA research has highlighted similar findings to some of those discussed here, such as music interventions providing people with dementia (e.g., Waters et al., 2022), communication disorders (e.g., Boster et al., 2021), or Autism (e.g., Navarro et al., 2025) with an environment having the opportunities and resources to express themselves, participate, and interact or connect with others more easily or frequently. CA can provide a tool for examining these events in an organized, sequential, moment-by-moment way.

In particular, it can make visible to practitioners elements of the interaction that may go by unnoticed or are taken for granted at the time (Holck, 2004). This could improve understanding of the resources being used and potentially allow for tailoring of musical care. For example, within this review, CA research illuminated how music/dance provided a framework that allowed participants in an intervention to predict what would happen next in an organized group activity and modify their behavior accordingly (Matérne et al., 2023), or determine when an action should be done so they could participate in a musical interaction (i.e., turn-taking; Kosurko & Stevanovic, 2023). CA research also demonstrated features such as how embodied behaviors like touch could be used to create “withness” in a dance activity (Kosurko & Webb, 2024), how performances could be co-created together (Kosurko & Stevanovic, 2023), and how trust and cooperation may be created and displayed between participants and others in the intervention, such as instructors (Matérne et al., 2023).

Finally, Kindell et al. (2018) discuss the importance of not neglecting positive “in-the-moment” effects on emotions and interactions, where temporary effects on quality of life can be very valuable (McDermott et al., 2013). The interventions in both Kindell et al.'s study and Matérne et al. (2023) demonstrated how CA could effectively capture particular moments of shared joy, fun, and authentic connection between participants. These show the value of musical care activities for providing positive, meaningful moments of interaction that can enhance wellbeing.

There are some limitations of this review. As mentioned previously, three of the studies presented here were not peer-reviewed, and indeed one only consisted of a conference proceeding article with limited detail (Roman, 2024). The decision was made to include these anyway, as it was thought to be more beneficial to provide an overview of all the research conducted, but readers should bear these limitations in mind. In addition, only research published in English was included. This skews the sample toward English-speaking countries (or countries where English is the main academic language) and may mean that relevant research from other languages or cultures has not been included. Future research should aim to embrace interaction and musical care contexts that go beyond Western settings as well.

In addition, only research explicitly labelled as CA was explored in this review (although several studies with similar-style methods were closely considered, see Supplemental Material). This means that research that is CA-based or informed, but not labelled as such, may have been missed. This may reflect CA's relatively unknown status in the musical health and care field, meaning that (similar to Flinkfeldt et al., 2022) a more accurate definition for this article might be research that has been categorized as CA, rather than conducted as CA.

Conclusion

Overall, this review has brought together and presented, firstly, a summary of the research that has explored musical care using CA and secondly, the benefits that an interactional analysis like CA can bring to different musical care settings. The prevalence of interaction and/or communication in musical care, either as an explicit goal or an important part of the care itself, suggests that CA would be well-suited to multiple scenarios where interaction could be evaluated, including (but by no means limited to) music therapy, music interventions, and music-making or musical interactions in both formal (e.g., instructor-led classes) and informal (e.g., singing in conversation) settings, particularly with people who may be less able to communicate in a more typical fashion.

Spiro et al. (2023) discuss how musical care often has a strength-based approach, where music is used to enhance, encourage, or tap into existing capabilities, rather than “fix” problems. The CA articles reviewed here today support that ethos, demonstrating how participants can use music creatively, effectively, and spontaneously as an embodied resource to support and progress the interaction they are taking part in, make connections with others, and display their own identity. CA is a particularly appropriate method for helping to demonstrate this. Its micro-analytic, inductive approach; focus on what participants in the interaction understand or respond to (rather than interpretation by the researcher); and adherence to the original verbatim verbal and nonverbal communication mean that, rather than focusing on what they might lack, it allows the participants and their abilities to shine through.

Supplemental Material

sj-docx-1-mns-10.1177_20592043261432814 - Supplemental material for Using Interactional Analysis to Explore Musical Care: A Conversation Analysis Scoping Review

Supplemental material, sj-docx-1-mns-10.1177_20592043261432814 for Using Interactional Analysis to Explore Musical Care: A Conversation Analysis Scoping Review by Kathryn Emerson in Music & Science

Footnotes

ORCID iD

Kathryn Emerson

Action Editor

Neta Spiro, Royal College of Music.

Peer Review

Saul Albert, Loughborough University, Communication & Media.

Lottie Anstee, University of Roehampton.

Consent for Publication

Not applicable.

Consent to Participate

Not applicable.

Ethical Approval Statement

This research did not require ethics committee or IRB approval. This research did not involve the use of personal data, fieldwork, or experiments involving human or animal participants, or work with children, vulnerable individuals, or clinical populations.

Author Contributorship

The author was responsible for conceptualization, data curation, analysis, investigation, methodology, project administration, resources, supervision, validation, visualization, and writing.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.

Supplemental Material

Supplemental material for this article is available online.

Appendix A

Search string:

(communicat* OR interact* OR talk* OR speech* OR “conversation analysis” OR “discourse analysis” OR discursive OR linguistic* OR sequen* OR embodied OR multi-modal) AND (music* OR singing OR choir OR danc*) AND (video* OR audio*) AND (health* OR wellbeing OR “well being” OR “well-being” OR hospi* OR therap* OR care OR clinic* OR communit*).

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