Ly L, Smallwood N, Hudson P, Goh N, Philip J. Ethnography of Singing for Breathing in COPD and ILD: Understanding Group Dynamics and Experiences. Am J Hosp Palliat Care. 2026 Sep 24:10499091261491309. doi: 10.1177/10499091261491309.
Abstract
Background/Aim
A growing body of evidence exists detailing the benefits of singing for lung health programs in improving participants' breathlessness and quality of life. However, the pandemic prompted a shift to online delivery, and there is limited understanding of how this mode of delivery impacts participants' interactions and engagement. This study aimed to explore how social connections and group interactions unfold within an online singing for respiratory illness national clinical trial, the SINFONIA trial.
Design
An ethnographic study including observations of 18 clinical trial participants with advanced chronic obstructive pulmonary disease and interstitial lung disease across 20 weekly sessions. Observations and quotes from participants were recorded using Spradley's field-note list, and thematic data analysis was used.
Results
Group members' interactions evolved over time with three themes emerging: (1) adaptation and community building; (2) evolution of group dynamics; and (3) dynamics of leadership and influence. As the singing program progressed, participants formed warm social connections that transcended geographical limitations. The program fostered a supportive environment where participants could share experiences of their chronic disease, appearing to promote resilience within the evolving group dynamics. Throughout the trial, the singing leaders' relaxed approaches to the classes and clinical backgrounds shaped the group dynamics.
Conclusion
Evolving relationships and group dynamics were observed within the singing program for respiratory illness, offering insights to inform delivery approaches and enhance participant engagement. Future work should explore how best to manage these dynamics and support leaders in balancing guidance with taking on organisational and leadership roles themselves.
Keywords: chronic obstructive pulmonary disease; chronic respiratory disease; ethnography; interstitial lung disease; quality of life.
