A Culturally Grounded Music-Based Intervention for Indigenous Older Adults in Long-Term Care: Protocol for a Mixed Methods Pilot Study.

Background: Indigenous communities continue to experience significant mental and physical health disparities associated with historical trauma, structural inequities, and disruptions to cultural continuity. Indigenous older adults residing in long-term care settings may be particularly vulnerable to social isolation, psychological distress, chronic pain, and reduced opportunities for cultural engagement. Music-based interventions (MBIs) have demonstrated potential for improving psychosocial and physical health outcomes; however, few MBIs have been culturally grounded in Indigenous worldviews or codeveloped with Indigenous communities. Objective: This manuscript reports the protocol for an ongoing pilot feasibility study evaluating a culturally grounded MBI for Indigenous older adults residing in long-term care settings in northern Arizona. The primary objectives are to assess the feasibility, acceptability, and implementation of the intervention, and to generate preliminary data regarding changes in mental health, pain, coping, and cultural connectedness. Methods: The study uses a quasi-experimental convergent parallel mixed methods design informed by the Indigenist Stress-Coping Model. The intervention was codeveloped through collaboration with a Community Advisory Board consisting of Indigenous elders, clinicians, researchers, and Indigenous musical consultants. The 6-session curriculum incorporates active music participation, including drumming, singing, storytelling, rhythmic engagement, and guided reflection. Participants are recruited from 2 residential long-term care facilities. Quantitative measures are collected before and after intervention participation and include assessments of depression, anxiety, perceived stress, pain, coping, and cultural connectedness. Qualitative interviews, observational field notes, and implementation data are collected concurrently to assess participant experiences, cultural relevance, intervention fidelity, and contextual factors influencing implementation. Results: This study was first funded in February 2024 by The NARBHA Institute and the James Wurgler, MD Endowed Chair. Continued funding was secured in September 2025 through the National Institute on Minority Health and Health Disparities through the Southwest Health Equity Research Collaborative Pilot Project Program (grant U54MD012388). Recruitment and intervention implementation began in March 2024 and are expected to conclude in May 2027. As of June 2026, 39 participants have been enrolled across 2 residential long-term care facilities. Quantitative and qualitative analyses are expected to begin in summer 2026. Findings will be disseminated through community stakeholder meetings, conference presentations, and peer-reviewed publications, with initial results anticipated in summer 2027. Conclusions: This protocol describes the development and evaluation of a culturally grounded MBI designed to support mental, physical, and cultural well-being among Indigenous older adults. Findings will inform intervention refinement, feasibility assessment, and future large-scale studies evaluating culturally responsive behavioral health interventions for Indigenous communities.