"We Need a Song of Hope": Responding to the COVID-19 Informational and Psychospiritual Needs of Residents of a Gated Community in the Philippines.

The brutal disruptions caused by the novel coronavirus (COVID-19) pandemic require dynamic ways of responding, not only to the informational needs of communities, but also engaging and creating interventions they consider relevant to their psychospiritual needs. Using the design thinking steps, we identified, developed and tested the type and nature of a unique song which residents of a gated community needed in their journey through COVID-19 lockdowns and government restrictions. The design thinking model provided clear steps for engaging residents to develop an anti-COVID-19 song of hope to cope with the physical, sociopolitical, psychological and spiritual trauma caused by the pandemic.

Introduction

The COVID-19 pandemic has left an unprecedented mark in the lives and well-being of individuals, families, communities and organizations. Till date, scientists are still battling hard to find pharmaceutical solutions to the problem. Meanwhile, countries are doing their best to implement non-pharmaceutical interventions (NPIs), such as prohibition of public gatherings, compulsory stay-at-home legislation, compulsory school closures, face mask rules and quarantine (Hartley & Perencevich, 2020). The intention of these measures is to protect and promote public health and well-being (WHO, 2020). However, these measures have led to anxiety, depression and distress (Bäuerle et al., 2020), coronaphobia (Asmundson & Taylor, 2020) and emotional impact (Brooks et al., 2020; Lima, Lopes & Brito, 2020; Lima, Carvalho, et al., 2020). Major culprits include frontline healthcare workers, individuals infected with and affected by COVID-19, individuals impacted by the prolonged restrictions, and individuals with existing mental health issues (Inchausti et al., 2020). Psychological support (Bäuerle et al., 2020) via hotline (Geoffroy et al., 2020), including spiritual care (del Castillo et al., 2020), has been used to mitigate the effects of the NPIs.

However, unusual situations require innovative designs within the context of the problem to achieve sustainability (Cankurtaran & Beverland, 2020; Valentine et al., 2017). The application of design thinking process is useful in searching and exploring complex health problems (Lewis et al., 2020), health systems issues (McLaughlin et al., 2019) and implementing public health solutions (Ramaswamy et al., 2019). Design thinking is useful, feasible and applicable to multiple health care domains such as diabetes, posttraumatic stress disorder, chronic obstructive pulmonary diseases and others (Altman et al., 2018). It can be used to create, implement and refine the health professions curricula and educational programs (McLaughlin et al., 2019) and address limitations of digital mental health interventions for youth (Scholten & Granic, 2019), men, women and children.

WHO (2020) supports context-specific social interventions that are acceptable and sustainable. Songs, a social intervention, have been used as a tool to transmit vital health messages (Aja et al., 2011). Currently, information on COVID-19 prevention and control is mostly transmitted in electronic forms and other media of communication, although in the wake of the COVID-19 pandemic, songs have been used to promote personal and collective responsibility on prevention and control (UNESCO, 2020). A song was presented by the Chinese Embassy in the Philippines as a tribute to frontline health workers (CNN, 2020), for those infected with COVID-19 (CGTN, 2020) and for friends and families (The Star, 2020). Other efforts include a musical concert by the World Health Organization (WHO), in partnership with Global Citizen to celebrate frontline health care workers; songs by musicians in Africa on COVID-19 protective measures; the Stay at Home Festival on Instagram live by The Orchard music company in the USA; and the Quarantine Fest in Spain (Global Citizen, 2020).

Songs alone or in combination with other interventions such as drama, dance and music have been used to increase early breastfeeding initiation and exclusive breastfeeding (Flax et al., 2014), send preventive messages about HIV/AIDS (Wenje et al., 2011), address development and health related issues such as chronic poverty, famine, disease outbreaks and family planning (Fayoyin & Nieuwoudt, 2017), treat dementia (Ekra & Dale, 2020), bring positive behavioral and social change (Calo et al., 2020), educate and improve knowledge about diseases (Yoshida et al., 2012) and improve healthy habits in women (Singh et al., 2017). Thus, use of songs could be one of the ways of reaching more people with COVID-19 preventive messages, particularly religious communities. Religious communities are known to use songs to manage stress (Hamilton et al., 2013). In this context, this study sought to identify, develop and test the type and nature of a song residents of a gated community needed in their journey through COVID-19 lockdowns and government restrictions. In the Philippines, religion is crucial to the well-being of the people (World Population Review, 2020) and tends to give meaning to life (Rovers & Kocum, 2010) in general. The lockdown policies and restrictions on religious gatherings impact on the spiritual lives of the population, thus requiring innovative approaches to deliver religious and spiritual services and care to members (Catholic Bishops Conference of the Philippines, 2020; del Castillo et al., 2020).

Methodology

This study used a cross-sectional study design, following the five stages of design thinking as a theoretical framework (Dam & Siang, 2021). These stages comprise: (1) empathize—research your users' needs, (2) define—state your users' needs and problems, (3) ideate—challenge assumptions and create ideas, (4) prototype—start to create solutions, (5) test—try your solutions out (Fig. 1).

Fig. 1

Application of the design thinking stages for responding to the COVID-19 informational and psychospiritual needs of residents of a gated community in the Philippines (based on Dam & Siang, 2021)

In stages 1 and 2, we invited 150 residents of a gated community to participate in an online survey to define the type and nature of a song that kept them going amidst COVID-19 pandemics. The validated semi-structured online Google survey form/questionnaire, developed in English Language, and sent through the group’s email addresses, sought information from residents, 18 years and above, who volunteered to participate in the study. Of the 150 participants invited to participate in the study, 46 residents completed the survey questionnaire: a response rate of 31%. The survey questionnaire in stages 1 and 2 comprised of four parts. Part A elicited information on the demographic profile of the residents. Part B sought open-ended data on sources of information on COVID-19. Part C focused on choice of COVID 19 songs residents listened to, and Part D assessed their willingness to participate in developing a COVID-19 song. We used descriptive statistics to analyze the data.

On the basis of the findings from stages 1 and 2, we created ideas (ideate—stage 3) around the type and nature of a song on COVID-19 preventive and psychospiritual messages the residents needed, such as Christian, secular or traditional songs. The processes involved in the development of the song included an initial draft of the lyrics and music by one of the investigators, review of the lyrics and music by three investigators and further reflections and revisions by the investigators/authors. All the processes were done via Zoom virtual meetings. The investigators created a song (prototype—stage 4) highlighting COVID-19 preventive and psychospiritual messages to address the informational and psychological needs of the residents. The investigators tested the song among residents who participated in stages 1 and 2 to determine the relevance of the song to their felt need (test—stage 5). The online Google form used to test the song elicited information on the demographic profile of the residents, confirmation of having listened to the song and their feedback concerning the song.

To ensure compliance with ethical standards of research, the investigators sought the permission of AIIAS Ethical Review Board (MIN: 2020–31) before embarking on this study. Participation in this study was voluntary. Participants were free to withdraw their consent and to discontinue participation at any time without penalty.

Results

The results of this study are in three parts. Part 1 presents the sociodemographic characteristics of the residents, including informational and psychospiritual needs assessment results. Part 2 presents the lyrics of the COVID-19 song, including informational and psychospiritual highlights of the song (stage 4). Part 3 presents the results of the validation of the song that emerged from stages 1 to 5 of the design thinking process.

Part 1 Of the residents invited to participate in the study, 46 (31%) completed the online survey. Twenty-nine (63%) were males, 26 (46%) were married, 14 (30%) were aged 40–45, twenty-five (54%) were from Africa, 24 (52%) with a Master’s degree, 36 (78%) were students and 45 (98%) were Christians (Table 1).

Table 1

Sociodemographic characteristics

Sociodemographic characteristics	Number	N = 46%
a. Gender
Male	29	63
Female	17	37
b. Social status
Married	26	46
Single	20	44
c. Age in years
40–49	14	30
25–29	12	26
30–39	10	22
50 and above	7	15
18 − 24	4	9
d. Continent of origin
Africa	25	54
Asia	14	31
Americas	7	15
e. Highest educational attainment
Master	24	52
College	12	26
Doctorate	10	22
f. Educational status
Student	36	78
Faculty	5	11
Staff	4	9
Other	1	2
g. Religion
Christianity	45	98
Others	1	2

Responses from the open-ended questions showed that the major sources of information on COVID-19 and categories of songs that kept residents going during the COVID-19 lockdown were from the social media and television, and Christian and secular songs, respectively. About 31 (67.4%) said they have heard of a song conveying COVID-19 prevention and control messages (Table 2a). On what residents learnt from the songs on COVID-19, they listed safety measures for COVID-19 prevention.

Table 2

Type and nature of a song

Statement	Number	%
a. Heard of any song used to convey COVID-19 message
Yes	31	67.4
No	15	33.6
b. Would like to listen to a song that conveys COVID-19 prevention and control messages
Yes	37	80.4
No	9	19.6
c. Nature of song to hear
Hope	24	52.1
Awareness	13	28.3
Resilience	4	8.7
Attitudinal change	1	2.2
d. Type of song to hear
Christian	36	78.3
Secular	3	6.5
Traditional	6	13
Other	1	2.2
e. Willingness to participate in a song
Yes	28	60.9
No	18	39.1
f. Willingness to play musical instrument
Piano	4	8.7
Guitar	6	13
Violin	1	2.2
None	35	76.1
g. Willingness to sing in my own language
English	21	45.7
Spanish	4	8.7
Filipino	0	0
Other	21	45.6
h. Willingness to be a part of the music video
Yes	23	50
No	23	50

On whether they would like to listen to a “new” song that conveys COVID-19 prevention and control messages and hope, 37 (80.4%) said yes (Table 2b). Majority of the participants said they would like a song of hope 24 (52.1%) and awareness 13 (28.3%) (Table 2c). Majority, 36 (78.3%) would like a Christian song (Table 2d).

Majority of the participants were willing to participate in developing a song that promotes COVID-19 prevention and control and hope, 28 (60.9%) (Table 2e). Six (13%) indicated interest to play guitar (Table 2f). On the preferred language of COVID-19 prevention and control songs, majority of the participants, 21 (45.7%) (Table 2g), indicated English Language and expressed willingness to participate in the music video, 23 (50%) (Table 2h).

Part 2 Based on the data presented above, we developed a song. Table 3 shows the lyrics of the five stanzas and the chorus of the song highlighting COVID-19 prevention and control, specifically on protective measures, personal responsibility (the role of each person in preventing the disease and saving lives), collective actions we need to take to protect others, including spiritual connections and action that foster hope amidst the trauma caused by the COVID-19 pandemic.

Table 3

Lyrics of the song on COVID-19 prevention and control

COVID-19 lyrics	Informational and psychospiritual highlights of the song
Every one of us should play a part to prevent the COVID-19	Collective action against COVID-19
Any choice you make affects everyone	Our choices have a multiplier effect
Be aware of what you do	Awareness is important
Avoid to touch your nose, mouth and your face	Personal preventive action
Keep a little distance from the crowd and friends	Physical/social distancing is essential
This is how we can prevent and save someone from Corona virus	Stay home
	Wash hands with water and soap
Stay at home for quarantine	Use sanitizer
Let’s prevent this COVID-19
Wash your hands with water and soap
Or use the sanitizer
When we trust in the Lord, we obey regulations for our well-being	Spiritual action
Do not take any rule for granted	Trust in God
Helping each other we can win	Obedience
	Victory together
Avoid to touch your nose, mouth and your face-	Personal preventive action
Keep a little distance from the crowd and friends—This is how we can prevent and save someone from Corona virus—	Maintain respiratory hygiene
	Physical/social distancing is essential
We believe in the promises of God	Spiritual action
Soon and very soon all these things shall pass	Believe in God and His promises
He cares for us, watches us, no need to doubt	Hope in God’s care and time
In His time, we’ll understand

Part 3 The results of the validation of the song among the residents show that of the 46 residents who participated in Part 1 of the study, 12 validated the song (response rate of 26%). Nine (75%) were males, 6 (50%) were married, 3 (25%) were across all the age groups, 7 (58.3%) were from Africa, 7 (58.3%) with a Master’s degree, 10 (83.3%) were students and 12 (100%) were Christians (Table 4).

Table 4

Sociodemographic characteristics of residents at pilot test of the song

Sociodemographic characteristics	Number	N = 12%
Gender
Male	6	50
Female	6	50
Social status
Married	9	75
Single	3	25
Age
40–49	3	25
25–29	3	25
30–39	3	25
50 and above	3	25
18–24	0	0
Continent of origin
Africa	7	58.3
Asia	4	33.3
Americas	1	8.3
Highest educational attainment
Master	7	58
College	2	17
Doctorate	3	25
Educational status
Student	10	83.3
Faculty	1	8.3
Staff	1	8.3
Religion
Christianity	12	100

Of the 12 who listened to the song, 11 (91.7%) liked it. Majority of the residents identified awareness, 11 (91.7%) and hope, 8 (66.7%) as the key messages of the song. One of the residents would like a “more vibrant tune” to be added to the song and for the song to be “shorter and less wordy.” Seven (58.3%) classified the song as Christian, and 9 (75%) indicated that the song should be translated to local languages: Filipino—2 (16.6%), French—2 (16.6%), Swahili—1 (8.3%), Amharic—1 (8.3%), Igbo—1 (8.3%), Khasi—1 (8.3%), and Mongolian—1 (8.3%) (Table 5).

Table 5

Residents’ assessment of the song

Statement	Number	%
Listened the song
Yes	12	100
No	0	0
Liked the song
Yes	11	91.7
No	1	8.3
Key messages of the songa
Awareness	11	91.7
Hope	8	66.7
Resilience	1	8.3
Attitudinal change	3	25
What to add to the song
More vibrant tune	1	8.3
Nothing	11	91.7
What to remove from the song
Short length and less wordy	1	8.3
Nothing	11	91.7
Song classification
Christian	7	58.3
Traditional	2	16.7
Secular	1	8.3
Others	2	16.7
Like the song to be translated
Yes	9	75
No	3	25
Like song to be translated to
Amharic	1	8.3
English	1	8.3
Filipino	2	16.7
French	2	16.7
Igbo	1	8.3
Khasi	1	8.3
Mongolian	1	8.3
Swahili	2	16.7
None	1	8.3

aMultiple responses

Discussion

Residents relied on social media and television as the major sources of information on COVID-19. Social media platforms are common sources of COVID-19 information (Ali & Bhatti, 2020), particularly via tweets (Gough et al., 2017). It is rapid (Chan et al., 2020), with obvious drawbacks (Lima, Lopes & Brito, 2020; Lima, Carvalho, et al., 2020), and requires filtering (Pariser, 2012).

The design thinking model provided a clear framework that can lead to innovative solution development (Cankurtaran & Beverland, 2020). In our study, we identified, developed and tested the type and nature of a song residents of a gated community needed in their journey through COVID-19 lockdowns and government restrictions. The profile of the participants suggests a diverse community of Christian residents, mostly students from Africa. International students are more likely to feel isolated (Wa-Mbaleka & Joseph-Collins, 2013) especially in the wake of COVID-19 pandemic and may need something more than information to cope with the pandemic.

In our study, the respondents tended to draw inspirations from Christian songs. Christian songs that address cognitive and emotive states (Tonsing et al., 2015) may be attractive to Christians in times of crises. Some kinds of music may improve blood pressure (Sutoo & Akiyama, 2004), enhance positive emotional states (McCraty et al., 1996) and can be used to educate and improve knowledge about diseases (Yoshida et al., 2012) and facilitate relaxation (Krout, 2007).

Right from the onset of the pandemic, there were varieties of music on COVID-19 (CNN, 2020; CGTN, 2020; The Star, 2020; Global Citizen, 2020). In our study, the residents indicated that they have heard of songs conveying COVID-19 prevention and control messages. Despite having heard of the songs, residents still indicated that they would you like to listen to a “new” song that conveys COVID-19 prevention and control message and hope. Perhaps, they wanted a song that not only provides information about COVID-19 but a song that connects them to God. The majority of the participants would not only want to hear a Christian song (a song of hope); they were willing to participate in developing a song that promotes COVID-19 prevention and control as well as hope. Songs have been shown to bring positive and behavioral changes (Caló et al., 2020), as well as educate and improve knowledge of diseases (Yoshida et al., 2012). The COVID-19 song from our study communicates risk with specific information on COVID-19 protective measures, personal responsibility, collective action and spiritual connection with God.

Limitations of the Study

This study is limited to one community. For this reason, the result may not be applicable or generalized to bigger population. Nevertheless, the result of the study could benefit other gated religious communities by serving as a platform for similar study in other areas of need.

Conclusion

The COVID-19 pandemic has left unprecedented mark in the lives and well-being of diverse cultures, including Christian communities. With the innovative action steps which the design thinking model provides, our study explored and responded to the COVID-19 informational and psychospiritual needs of residents of a gated community in the Philippines by developing and testing a song. The findings of our research corroborate the positive impact of songs of hope on stress. In response to the participants’ desire for a song of hope, this study concludes that the design thinking model provided clear steps for engaging residents to develop an anti-COVID-19 song of hope to cope with the physical, sociopolitical, psychological, and spiritual trauma caused by the pandemic. We recommend that future research should utilize the design thinking model to assess residents’ informational and psychospiritual perspectives and needs in other crisis issues beyond COVID-19, as well as evaluate the impact of the COVID-19 song on the prevention behavior of residents.