105 Music for Hospitalized Children in Service-Learning: Academic and Personal Implications for Teachers in Training Desirée García-Gil, Laura Cuervo, Carolina Bonastre, Celia Camilli Complutense University of Madrid, Spain Submitted: 2023-03-22. Revised: 2024-05-09. Accepted: 2024-06-14 Abstract Service-learning methodology seeks to achieve a balance between academic learning and the application of the acquired knowledge for the benefit of the community. Our study aims to as- sess the academic and personal development of the students who participated in the educational experience and identify the benefits it brought to the attended children. The total of 73 partici- pants involved: a) university students of a faculty of education, b) hospitalized children and their families, c) a healthcare worker, and d) several volunteers. We conducted a case study featuring qualitative analysis (based on discussion groups, interviews, and daily narratives), analysis of co- occurrence, and data triangulation. The categories we obtained were related to learning achieved by university students, their personal growth, and the impact of hospital service on the different agents who participated in the experience. Findings suggest that service-learning, along with the positive emotional impact of experiential music learning, was associated with student progress in teacher training and personal development. Keywords: service-learning; music education; hospitalized children; case study, higher education How to Cite: García-Gil, D., Cuervo, L., Bonastre, C., & Camilli, C. (2024). Music for Hospitalized Children in Service- Learning: Academic and Personal Implications for Teachers in Training. Harmonia: Journal of Arts Research and Education, 24(1), 105-121 Harmonia: Journal of Arts Research and Education 24 (1) (2024), 105-121 Available online at http://journal.unnes.ac.id/nju/index.php/harmonia DOI: http://dx.doi.org/10.15294/harmonia.v24i1.43375 contexts, S-L does not merely focus on the acquisition of knowledge foreseen in the study syllabus but also encourages the development of critical faculties (Chiva- Bartoll & Gil, 2018). S-L enables students to acquire future teacher competencies, such as committing themselves to the needs of their social environment, applying critical reflection while responding to real-life ser- vice situations, and reinforcing student’s capacity for independent learning. Mo- reover, in S-L environments, beneficial reciprocity is given between their partici- pants (Clayton et al., 2013). In this vein, Deeley (2016) and Yorio INTRODUCTION The educational model of Service- learning (S-L) is rapidly becoming a global phenomenon. Its aspect of social engage- ment is grounded in concrete daily expe- rience, responding to an increasing need for holistic learning methodologies related to current social reality and encouraging students to reflect ethically (Belando-Mon- toro & Sánchez-Serrano, 2017). As a teach- ing methodology that can be applied on a variety of educational levels, especially in preservice teachers’ education (Camilli et al., 2021) and in many different learning Corresponding author: E-mail: desiree.garcia@edu.ucm.es p-ISSN 2541-1683|e-ISSN 2541-2426 Harmonia: Journal of Arts Research and Education 24 (1) (2024): 105-121106 and Ye (2012) outline other effects achie- ved by S-L projects, such as (1) enhanced sense of citizenship, (2) accelerated intel- lectual development, and (3) personal de- velopment, as each student has the oppor- tunity to deepen into their own beliefs of social and ethical values. Together with this, students acquire skills that can be transferred to their futu- re professional context (García & Lalue- za, 2019); upcoming teachers, meanwhile, achieve an enhanced perception of their teaching work prior to and after the S-L experience (Kovalev et al., 2016), as they are key in its implementation. For all these reasons, an increasing number of authors find that this learning methodology has considerable potential for improving the quality of education (Mella-Núñez et al., 2015); however, it should be pointed out that it is a highly complex process highly complex (Burton & Reynolds, 2009; Chiva- Bartoll & Gil, 2018). According to Chiva-Bartoll et al. (2019), most benefits stemming from mu- sical S-L activities on the higher educatio- nal level are associated with the effective- ness of learning (76.47%), the acquisition of social skills (47.06%), and changes in students’ understanding of global society (17.65%). In reference to benefits for the agents who receive the service, the same authors highlight the acquisition of musical learning (29.41%), personal skills (17.65%), and social skills (17.65%). In other words, the learning achieved by all participating agents is a major advantage of S-L. In this respect, Pike (2017) evaluated the positive progress achieved by graduate pedagogy interns which provided the service as well as beneficiaries in a study where social and intellectually disadvantaged students were taught to play musical instruments: the author likewise highlighted the lear- ning achieved by the preservice teacher- candidates who participated. Moreover, music taught through S-L methodology can improve socio-emo- tional aspects relevant for future teachers and increase participants’ sensitivity to social problems (Riaño et al., 2017). Mo- reover, the experience of a “real” learning environment can help university students understand music’s potential for impro- ving psychological and emotional growth in children (Gillanders et al., 2018). A study by Sáez and Marín (2016) documents the satisfaction expressed by the families of schoolchildren with an S-L project that featured choral singing and traditional dance activities. The experien- ce promoted a series of values that could serve as a bridge between school and so- ciety: effort, self-improvement, teamwork, helping others, and empathy. Similarly, in another project (Parejo et al., 2020), parti- cipating teacher candidates in the area of music education developed their social and civic competencies by improving their understanding of socio-cultural diversity and reinforcing their grasp of coeducation. On the other hand, hospitals can pro- vide an appropriate environment for mu- sic-based interventions: positive effects on mental and physical health can be achie- ved by encouraging patients to participate in interactive activities or simply by let- ting them enjoy music performed live on the premises (Facchini & Ruini, 2021). The findings of a Singing Medicine project in a children’s hospital showed that partici- pation in such an ‘arts-in-health’ initiative was associated with benefits for children who suffered from long-term conditions, as well as for their families: specifically, a reduction in negative emotions along with the achievement of enhanced well-being through distraction and the sharing of po- sitive experiences (Blackburn, 2020). In this vein, music is regarded as an adjunct method of pain management, as well as a good means of relieving children’s stress and anxiety when they are hospitalized (Jonhson et al., 2021). The- re is evidence of the empowering effects of hearing and/or performing music, leading to positive effects in children in the short- stay observation unit of an emergency de- partment (Antonelli et al., 2019). Other stu- dies show that music-based activities help children deal with the psycho-emotional effects of chronic diseases (Montero-Ruiz Desirée García-Gil et al., Music for Hospitalized Children in Service-Learning: Academic 107 et al., 2020). As an art form that features emotional and abstract content, music can express and trigger emotional reactions (Orozco, 2013), which is highly important for future teachers. Expressing emotions through musical activities becomes impor- tant when pain and anxiety inhibit patients from expressing their emotions verbally. Occasionally, it is even possible to take a further step and boost patients’ creativity, thereby providing them with satisfacti- on and positive feelings (Tanquerel et al., 2018). Ensuring that children who spend prolonged periods of time in the hospital are provided with opportunities to play and express themselves should be a pri- ority for healthcare services (Blackburn, 2020). Musical intervention can also be seen as a means of improving the well-being of family members, as the hospitalization of their children often tends to be a trauma- tic and stressful event for them, involving deprivation in the affective and cognitive areas. Findings from recent studies show that musical mediation can reduce the le- vel of post-operative anxiety experienced by family members of children submitted to surgery (De Oliveira et al., 2018). Playful music activities in a pediatric hospital envi- ronment also help to distract sick children from the hardships associated with their illness while improving their degree of so- cialization, engagement, and involvement, their quality of learning, their confidence, as well as their relationship with their fa- milies (Issaka & Hopkins, 2017). This paper’s general purpose is to analyze the impact of the implementation of a S-L experience in the Music Educati- on portion of a university Early Childhood Education Teacher’s degree course during the 2019/20 academic year. Our specific objectives are: a) to assess the academic and personal development of the students who participated in the educational expe- rience and b) to discover the social impli- cations for the agents involved in relation to the provided service. METHOD Design We used a case study design in which the experience of applying S-L in music education on a university level was taken as a holistic unit of analysis (Yin, 2014). This is an intrinsic case study that deals with ‘the case’ without claiming that it is representative, on the grounds that it has value and interest in itself (Fusch et al., 2018; Stake, 2005). Participants The study sample was comprised of 73 subjects: 43 future educators enrolled in public universities in Madrid, 20 children interned in public hospitals in Madrid, six families, one healthcare worker, and three healthcare volunteers. The 43 students (90.7% female) had an average age of 18.91 (range: 18: 19-23, DT=0.95): 34.6% of them had previously been involved in some form of volunteer work (in associations for the disabled, NGOs, community kitchens, residential care facilities for the elderly, and food banks, as well as in activities rela- ted to children and sport); 48.8% of the stu- dents had prior knowledge of S-L, mainly acquired at university, although 93% of them had not previously participated in such experiences. Only 25.6% had enga- ged in previous musical studies through formal or informal learning. Around 20 hospitalized children and six families took part, thereby accounting for ca. 30% of the families of all the hospitalized children in the sample. The informed consent process was applied, and APA ethical standards concerning the treatment of human sub- jects were fulfilled. Data Collection and Analysis Our data collection techniques were personal narratives, discussion groups, and semi-structured interviews, which are frequently used in S-L studies (Ca- milli et al., 2018). The university students wrote personal narratives on a weekly ba- sis throughout the semester, reflecting on their degree of involvement and implicati- on in their learning of the subject and the Harmonia: Journal of Arts Research and Education 24 (1) (2024): 105-121108 service they performed. We analyzed 80 narratives in total. We also organized two discussion group rounds: one prior to the service and one thereafter. The five informants in these two discussion sessions were selected ac- cording to pre-established criteria to form a heterogeneous group. The script focused on three key themes: 1) the training they received in the course, 2) social and cross- cutting skills related to the subject, and 3) the social impact generated before and af- ter the implementation of the proposal. The discussion group organized after the ser- vice focused particularly on the third the- me. The semi-structured interviews were conducted with families, hospital staff, and hospital volunteers, who were asked questions regarding 1) the importance and benefits of the experience, 2) the training of future educators for initiatives of this type, and 3) eventual forms of cooperation bet- ween universities and hospitals. In the qualitative phase, we examined the students’ personal narratives, discussi- on groups, and semi-structured interviews by applying an inductive analysis that es- tablished links and associations among the data to find identical or similar patterns of meaning (Creswell & Plano, 2017). As this is a case study, we applied categorical ag- gregation and direct interpretation (Stake, 2005). Emerging categories were subjected to inter-rater evaluation among the four investigators of the study, achieving an 87.5% match. We also obtained a co-occur- rence coefficient based on content analysis (Lund et al., 1995), and we quantitatively analyzed the final categories with their res- pective codes (frequencies and percenta- ges). All qualitative analyses were carried out using the Atlas.ti software. In the quantitative phase, we app- lied contingency analysis using Cramer’s V measure, which works with nominal variables: this is the same type of analysis carried out in other studies such as Ricoy and Sánchez-Martínez (2020). The V value ranges from 0 to 1, whereby 0 indicates a total lack of association between two va- riables, and 1 is a perfect match. Values above .80 indicate a very strong associati- on, between .60 and .80 a strong associati- on, between .40 and .60 relatively strong, between .20 and .40 moderate, between .10 and .20 weak, and below .10 negligible (Rea & Parker, 1992). All quantitative ana- lyses were conducted with STATA version 13.1. Following the indications of Sta- ke (2005) and Yin (2014), we conducted a triangulation of sources (personal narrati- ves, interviews, and focus groups) desig- ned to improve the credibility of results (Fusch et al., 2018) and obtain a more complete understanding of the role of S-L in university musical education. A variety of strategies ensure that this study comp- lies with the quality criteria for educational research proposed by Lincoln and Guba (2000), such as credibility, transferability, dependability, and confirmability. Procedure During four months of the 2019/20 academic year, we applied the S-L met- hodology in the course entitled “Deve- lopment of Musical Expression” featured in the third year of the studies toward a university degree in Early Childhood Edu- cation at a public university in Madrid, as part of an innovation project. We schedu- led a service in a children’s hospital (Mad- rid) with the collaboration of the NGO “Música en Vena” (“Music in the Vein”). The project’s main goal was to develop ci- vic skills and a spirit of initiative among university students while improving the quality of learning by increasing their mo- tivation. The teacher acted as a guide, and the students participated actively in the entire process, including identifying the sick children’s needs, resolving problems using a multi-perspective approach, and a continual, guided critical reflection on the experience as it progressed. Our met- hodology was experiential and skill-based, while the academic contents were related to the reality of the hospital, supported by ongoing reflective practice. With the goal of preparing the students for their profes- sional lives as part of society, our process Desirée García-Gil et al., Music for Hospitalized Children in Service-Learning: Academic 109 aimed to achieve a significant cooperative learning experience through S-L. Throughout the course, small groups of six students were formed to work on creating musical stories as well as compo- sing songs and rap numbers for children, all related to the Spanish musical heritage, in particular, to Spanish composer Manuel de Falla. For example, the musician’s biog- raphy was sung as a story, and rhythms and harmonies from Fallas’ works and themes and characters from his theater works were used. Once the activities had been prepared and rehearsed, each small group performed them in the hospital by interacting with the children. As sup- porting elements for their performance, the course students created appropriate choreographies, dramatizations, stage de- signs with pictures of Falla, and costumes inspired in his theater works. They also built instruments and crafted pictograms and cards to be handed out as gifts to the children. Hospitalized children inter- acted to the best of their ability, following the rhythm with movements, playing the instruments, and singing. In this way, each student had the op- portunity to meet their individual goals while participating in common goals, to have the experience of proving themselves responsible by making a fair contribution to the overall group endeavor, to make an effort to maintain positive interpersonal relations, and to analyze the results a pos- teriori. Students wrote down their analy- ses and reflections in their class notebooks (personal narratives). RESULT AND DISCUSSION Qualitative Analysis: Emergent Catego- ries Qualitative analysis yielded a total of nine categories confirmed by 88 codes and 1,584 quotes (Table 1). Most codes were associated with the following categories: impact on the area of emotions (23.86%), impact on musical knowledge (20.45%), and impact on S-L methodology (19.32%). Textual quotes are identified accor- ding to the technique we used and the actors involved for ease of reading. Speci- fically: PSN = personal student narrative; SDG=student discussion group; FI = semi- structured family interview; HSI= semi- structured health staff interview and VI= semi-structured volunteer interview. The categories are presented below. S-L Methodology. S-L is much more than an activity or a volunteer program: in S-L, the education of participating students is actually the main goal. In our case, the service we provided was associated with a course in the subject of music (“This acti- vity has been very important for our future as teachers, since at some moment or other we will need to feature a song with a dance in order to teach it to the youngest ones” [PSN]). The ser- vice we provided required a considerable amount of preparation and an active met- hodology (“Moreover, the class is less mo- notonous; it becomes creative and much more fun” [PSN]). It featured a strong connecti- on between theory (curricular content) and practice (“During this session we have dealt with some of the most important concepts in the school subject of music” [PSN]). S-L is a methodology unknown to some (“The teacher has explained that we’re going to have a service-learning project du- ring the course. I didn’t know what that is, but she has explained that it is a methodology through which we not only develop curricular content, but also social competencies and va- lues” [PSN]). Although it has its own set of difficulties, particularly the time required for planning and putting it into practice, it is still thoroughly interesting (“I have found the configuration and presentation of the course quite interesting” [PSN]), because it emphasizes organization in workgroups (“Organizing our groups to enact the story, we have focused on the service we will provide to the hospital. I’m sure we’re going to do it very well. Still, we all have to put in some work if we want to achieve a good final result” [PSN]). S-L becomes a way of helping others: it benefits the students who participate in the activity as well as those toward whom the service is directed (“At the hospital, we’re going to help the children feel positive https://1drv.ms/w/s!AocbnejlAoD2fwV4V8GacpH21Mk?e=P8xM4N Harmonia: Journal of Arts Research and Education 24 (1) (2024): 105-121110 Table 1. Emergent categories from qualitative analysis Categories Codes Quotes n % n % S-L methodology service, music subject, challenge, active methodology, organizing in groups, theory-practice connection, helping others, benefits, preparation, unfamiliar methodology, difficulties, interesting, experts, suggestions for future projects, experience, putting into practice, activity 17 19.32 355 22.41 Impact Musi- cal knowl- edge melody, rhythm, interpretation, cre- ation, songs, Manuel de Falla, music, complications, expression, instruments, performance, movements, choreograhies, coordination, creativity, dance, accompa- niment, instrumental, rap 18 20.45 382 24.12 Social group cohesion, working in groups, dif- ficulties, communication, spirit of initia- tive, society, citizenship, community 8 9.09 67 4.23 Cogni- tive thinking, reflecting, time management, reasoning 4 4.55 62 3.91 Emo- tional enjoyment, empathy, engagement, self- esteem, effort, meaning of life, involve- ment, implication, commitment, manag- ing frustration, anxiety, stress, critical thinking, memories, pride, gratefulness, happiness, trust, fear, shame, interest, motivation, feeling inspired 21 23.86 274 17.30 De- velop- ment of com- peten- cies competencies associated with ECE cur- riculum, competencies associated with the university degree (general competen- cies, specific competencies, transversal competencies), professional competen- cies 8 9.09 186 11.74 Teach- ing teacher’s role, faculty, university 3 3.41 31 1.96 The service benefi- ciaries familiarization with the hospital environ- ment, generosity, involvement 3 3.41 91 5.74 Evaluation of the service-learning project level of satisfaction, self-evaluation, co-evaluation, improvement, valuing, importance 6 6.82 136 8.59 Total 88 100 1584 100 have acquired” [PSN]). The learning experi- ence as such is also acknowledged by the families of the hospitalized children (“I can imagine that it’s also interesting for the stu- dents when they’re training, since they learn how to reach out to the children and communi- cate with them” [FI]). The students positively evaluated emotions”; “It’s incredible to see to what de- gree music can help people”; “We can help them forget their illness for a while” [both from SDG]). S-L represents an academic challenge that requires a considerable lear- ning effort on the part of young university students who are in initial training (“We can help others while using the knowledge we Desirée García-Gil et al., Music for Hospitalized Children in Service-Learning: Academic 111 that music experts were invited to the course, as this allowed them to broaden their musical knowledge; moreover, the project provided them with deeper insight into what goes on in hospitals, and even led them to think back on their personal life story. As suggestions for future pro- jects, the course students proposed that S-L could be applied in the hospital class- room combined with other subjects inclu- ded in the syllabus of other educational levels. (“For instance, in history [as a subject in primary school] we might be able to work in a hospital with the children who are interned as patients there: since there are parts of their class content they can’t study while they’re in hospital, you can take it to them as a drama- tization, or as a game, or something like that, so that they learn that portion, too” [SDG]) or in other pedagogical university cour- ses (“I want to recommend that you carry out such projects with other students so that they can have the same kind of experience” [PSN]), putting S-L into practice in a multitude of different environments, such as student residences (“The older students can help the younger ones, who can thus carry out the acti- vities without any problem” [PSN]). Music Knowledge: Implications. The students learned the didactic impli- cations of melody and rhythm, practiced instrumental accompaniment, developed songwriting creativity, and learned how to interpret various musical repertoires. By dealing with the music of Manuel de Falla, the students were able to grasp the complexity of musical language and how its contents are interrelated. The students positively highlighted the act of playing each instrument, the act of representation through choreographic movement, and the necessary body coordination in dance, particularly in rap. When students acquire musical knowledge, they are able to pro- ject themselves into their role as future te- achers. S-L and its Impact on Social Coe- xistence. Collaboration among peers was another important learning experience for the students who participated in this project. Working in small groups led to good cohesion in the entire class. Students affirm this in comments such as the follo- wing: “In dealing with such subjects as trying to become better people [referring to S-L], we have a pretty good atmosphere of solidarity in the class” (PSN); “Today we had our dress re- hearsal for all the repertoire we’ll be taking to the hospital. We were very excited, and we have worked together well in groups. We all felt con- nected by feeling the thrilled anticipation that we’re going to perform in front of the children, and by the idea that we’re going to help them with our compositions” (PSN); “Knowing this [referring to the importance of the service provided] has motivated us a great deal, and we have good rapport among colleagues; you can sense that we all want the performance to go really well” (PSN). Nevertheless, group collaboration is not exempt from difficul- ties, some of which are associated with the problem of finding the right moment to work together: “To prepare and rehearse the story, we need extra hours apart from those we have in music sessions, and it’s hard for us to agree upon a time slot to meet on the same day” (PSN). Other difficulties lie in main- taining good communication or reaching joint agreements. “Besides, when we want to start working together on a certain proposition, it is difficult for all the members of the group to reach an agreement as each person has a dif- ferent opinion” (PSN). Certain participants nevertheless point out that such a diver- sity of viewpoints ultimately enriches the performance project: “It’s positive to note that since there are many points of view, this enriches our collaboration since not everyo- ne comes up with the same ideas, and some of them can be brilliant” (PSN). The non-profit organization “Music in the Vein” (Música en Vena) aims to use culture and music to improve prolonged stays at hospitals for patients, families, and health staff. The university students’ encounter with this project sparked their sense of social initiative; they felt a greater commitment and responsibility for society, which, in turn, re-energized their concept of citizenship and community: “I’ve truly realized that we can improve everything that has to do with being more responsible and com- Harmonia: Journal of Arts Research and Education 24 (1) (2024): 105-121112 mitted people for the society in which we live” (PSN). S-L and its Impact on Cognition. The S-L experience leads students to reflect upon their concrete practice continually. “Today’s practical session made me reflect that the songs need an instrumental accompani- ment, which can be quite simple, playing se- veral notes and playing around with the tune and the lyrics” (PSN). It also leads to more critical, reasoned thinking: “I liked this a lot; I had never stopped to think that we could acquire further competencies that are less re- lated to curricular content and more with our own personal development” (PSN). Students likewise improve in the way they manage their time schedule. “I would generally say that we’re on the right path; our efforts and the time we put into this will lead to a good result” (PSN). S-L and its Impact on Emotions. Music “draws people together and cheers the heart;” it accompanies people in difficult moments of their lives. “Music has helped me in my worst moments; it has helped me re- lax when I was nervous or when I was particu- larly sad” (PSN). The shared experience provided a welcome occasion for enjoyment. “This ini- tiative to help the children find some distrac- tion is really good, really cool. And it’s true: they have fun, particularly with the music. They love it, especially getting to see the stu- dents perform live, which is even better” (FI). It also led to a greater deal of commitment on the part of the students: “We decided to do our best for the performance to turn out as well as possible” (PSN); “I hope I don’t let the group down. I want everything to turn out per- fect” (PSN). There was empathy among the classmates, but they also valued empathy when they imagined themselves in their future role as teachers: “In this way, we can educate the children in values such as empat- hy and solidarity, taking them to activities in which they will have to help those who are most in need” (PSN). They acknowledge the effort and commitment involved in this type of ini- tiative. “The effort has been substantial; the work we put in hour after hour for many days has been taxing, and we’ve constantly been ‘on the edge of our seats’ until the last moment” (PSN). The students affirm that the service increases their self-esteem. “This rehearsal turned out pretty well, and our self-esteem inc- reased considerably” (PSN). It also improves their self-assurance: “Self-confidence is so- mething you can later apply during your uni- versity training to situations of public expos- ure, for example: it’s like when we’re playing music there in hospital, we’re also working in a certain sense: you learn to face an audience and not to worry if you make a mistake. You learn to control your nerves and all that” (PSN). It leads them to reflect upon the meaning of life. Learning to deal with frustration, an- xiety, or stress is also part of life. A feeling of pride, gratitude, and a state of personal contentment were part of the emotional mark left by this experience. S-L and the Development of Com- petencies. S-L worked in favor of the development of general competencies, such as understanding the biological and psychological evolution of 0-to-6-year-old children, as well as specific competen- cies, such as knowing how to recognize and evaluate the use of non-verbal lan- guage associated with music. Some of the transversal competencies acquired by the students were the following: 1) becoming familiarized with the social and educatio- nal dimension of interaction among peers and knowing how to encourage participa- tion in collective activities and cooperative work while applying individual responsi- bility; 2) promoting educational activities that foster the kind of values that prepare students for the exercise of active, demo- cratic citizenship; 3) valuing the impor- tance of leadership, initiative, creativity, and innovation in the professional world; 4) acquiring a capacity for independent work, finding good methods of collective organization, and promoting independent learning. The students involved in the project learned more about the main stages of mu- sical development in infancy; they used their auditory, vocal, and body language Desirée García-Gil et al., Music for Hospitalized Children in Service-Learning: Academic 113 capacities to acquire the necessary techni- ques they could subsequently put into practice in performance. They also learned the correct use of basic musical language for didactic adaptation purposes, and they learned to ascertain which are the most appropriate musical instruments for Early Childhood Education. The students high- light the fact that the competencies they need to develop for the service are related to ECE curriculum content. S-L and its Impact on Teaching. The students regard the teaching-learning pro- cess as the transmission of knowledge on a subject that plays a role in their training to become future teachers. Those who recei- ve the service feel similarly: “It’s fascinating when they teach you something, and you can then teach it to someone else who, at the same time, teaches you something in return” (PSN). The students also favorably valued the professor’s role in the experience, and they highlighted the positive role of the ad- vice, follow-up, and feedback with which they were provided in each one of the tasks. For instance, referring to the course professor, one of them stated: “I principal- ly value the importance she has given to our interaction with the children” (PSN). They acknowledge the effort and the challenge it represents for university professors to implement the S-L methodology: “I would like to thank the professor […], for the patience she has shown with us for many days, especi- ally since sometimes it was impossible to achie- ve silence in the class” (PSN). Furthermore, S-L transcended the classroom context and enabled the students to achieve a greater sense of identity and belonging within the education faculty and the university. Beneficiaries of the Service. Each one of the agents involved in the experience no- ted not only the personal benefits achieved by their own actions, but also those achie- ved in favor of others. Family members of the hospitalized children acknowledged that student participation brought the fa- milies closer to the hospital environment: “It’s important that people from outside the hospital share a moment with us by involving themselves since this is a totally different envi- ronment from what they are used to” (FI). S-L encourages the development of qualities such as generosity. “It is a way of applying the generosity the students have; in the end you also learn, and when they share it by presen- ting it, I think it’s good for them, too” (FI). S-L gives rise to a series of interactions: “Well, they learn to share something with the children: they see how the children evolve and deal with the situation. In other words, dealing with the children is a good learning experience, particu- larly dealing with those who are in hospital, as they are here. This way, [the students] begin to get to know different types of children, and what they are like” (FI). Regarding potential benefits for their children, the parents found that the servi- ce helped the children enjoy a moment of evasion from their daily routine, providing them insight into musical culture. The stu- dents, for their part, noted that staff who work with people with illnesses show a profound commitment, and the staff than- ked them for their participation and invol- vement in the project. “When we arrived at the hospital, the nurses gave us a warm welcome” (PSN); “I want to highlight so- mething one of the nurses said to us: she thanked us for our work. But the ones who were most grateful at that moment were we, ourselves, for being able to participate in that project and bring music to hospitals to make the children happy” (SDG). The mother of a boy with functional diversity also said something that caused the young students to reflect: “Besides, a family with whom we were talking suggested that in the classroom we should focus more on children with functional diversity” (FI). The health staff valued the experi- ence as an exchange, and a window of op- portunity to raise awareness of the work carried out with children in the hospital. Hospital volunteers highlighted the mu- sical knowledge acquired by the hospi- talized children: for these volunteers, the experience was also a training opportuni- ty since they are not experts in education. “I would say that my evaluation is positive: I particularly see the positive aspect in what they teach. It’s not a mere spectacle that doesn’t add Harmonia: Journal of Arts Research and Education 24 (1) (2024): 105-121114 anything for the children. Today, for instance, they will have learned who Manuel de Falla was; perhaps when they went into hospital, they didn’t know who he was. That’s the po- sitive aspect I see, apart from the fact that they are entertained, they learn, and they have fun” (VI). Evaluation of the S-L Experience. The students are also constructively critical of their classmates (co-evaluation), ackno- wledging the strengths of the project they all worked on together. “On the one hand, I just want to say that I have loved my classma- tes’ performance. I think their work and effort have been tremendous, and it’s reflected in the results” (PSN). They also have suggestions for improvement: “Each group’s stories are well thought-out. We’re nevertheless all well aware that there’s room for improvement” (PSN). Ultimately, the students evaluated the experience as satisfactory. One of them referred to the visit at hospital with the performance in the following terms: “As far as my level of satisfaction, enjoyment, and personal contentment is concerned, this has been one of the most useful days I have ever ex- perienced in the course of my studies” (PSN). Several of them highlighted the importan- ce of S-L in their initial training: “I find this very good because at university, we don’t think about those things [referring to service and those who receive it], but in the end they’re important for our future profession as teachers, and in helping ourselves to become better peop- le” (PSN). Qualitative Analysis: Analysis of Co-Oc- currence The 88 codes that made up the nine categories of the study were subjected to a co-occurrence analysis through the Atlas.ti program. The process segmented the text into three educational and social aspects related to our research goals: (1) learning in the university classroom achieved by the students; (2) the personal development of these students, affecting their personal li- ves; and (3) the hospital service, covering the point of view of the different agents who participated in the service scenario. Quantitative Analysis: Data Triangula- tion With the information obtained from data co-occurrence, we estimated Cramer’s V in order to obtain the degree of associa- tion between the suggested aspects, there- by determining and completing the strong and weak points of the qualitative and quantitative analysis. We analyzed the co- des and grouped them into the categories as explained above. Table 2 compares the values grouped by those categories. Signi- ficant associations were found in the values of 3 out of 4 of the categories that emerged from the qualitative analysis (impact were gathered in a total category): lower percen- tages in Service-Learning methodology for the learning in the university group, higher percentage of co-occurrence for this group in the total impact; and higher percentage for the hospital service group in service be- neficiaries; with no statistically significant associations for evaluation. For specific ca- tegories of impact, there were statistically significant associations for social impact (p<.001) and trends to significance for cog- nitive (p=.08) and development of compe- tencies (p=.07) (Tabla 2). The number of quotes is reasonably lower for co-occur- rences than for those that emerged from qualitative analyses. Discussion We conducted this study to assess the design and effects of S-L methodology on the preservice training of general teach- ers who are going to impart educational and musical content in the classroom. Re- garding S-L methodology, the following aspects need to be taken into account. Alt- hough the S-L methodology was unknown to most of the participating students, it re- vealed itself as ideal for the improvement of all kinds of learning. Processed through continual critical reflection, these experi- ences may have aided in transforming the students’ vision of surrounding society, activating their spirit of initiative through their desire to participate actively in the hospital service. The students’ expressions Desirée García-Gil et al., Music for Hospitalized Children in Service-Learning: Academic 115 of gratitude for participating and sharing their learning seem to well reflect the ef- fectiveness of S-L in activating processes of reflection and transformation. These could form the basis for a commitment to social transformation in the future, thereby corroborating results obtained in previo- us studies in this field (García & Lalueza, 2019; Larsen, 2017). Concerning the Impact on Musical Understanding category, the students re- ported good learning quality in acquiring knowledge and in their application of the service. In support of this idea, Larsen (2017) also related such improvement to the development of self-management of time and effort, autonomous planning, and self-assessment of the effort itself. Co- des such as thinking and time management associated with cognitive processes appear frequently in our study’s quotes. The pre- paration of the service and its assessment have shown how the learning of skills re- lated to the university course tend to deve- lop, along with their relationship with the Early Child Education curriculum, inclu- ding professional skills achieved thanks to a spirit of initiative by incorporating the students into work environments and en- couraging them in their role as active citi- zens (Mayor & Rodríguez, 2016). In addi- tion, the high level of frequency of codes such as group work and group cohesion (56%) reflect this methodology’s experiential and socializing nature through the acquisition of skills, above all in classroom learning, with a significant co-occurrence in the So- cial Impact category. The results of our data analysis sug- gest that attention should be paid to a se- ries of educational, personal and social aspects. In the results in the Emotional Im- pact category, statistically significant diffe- rences can be observed in certain inherent characteristics of S-L, such as connection to social reality and reflection encouraged by emotional processes and positive fee- lings, all of which is in line with previous studies (McKay-Jackson, 2014). Frequent references to effort, enjoyment and gratitude are notable on the part of the students and their families. In addition to these positive perceptions, one can also note the promi- nence of the generosity code in relation to hospitalized children and their families. Swarbrick et al. (2019) explain that the emotional awareness provided by music is particularly strong if the musi- cal activities are experienced live and as a group, as was the case in this study. In Table 2. Comparison of co-occurrence of the emerging categories between different education- al/ social aspects. Category 1 2 3 V Chi2 (p) N 250 181 90 --- --- S-L methodology 22 (8.8) 41 (22.7) 8 (8.9) .19 19.2 (<.001) Impact (total) 174 (69.6) 102 (56.4) 58 (64.4) .12 8.0 (.018) Musical knowledge 43 (17.2) 27 (14.9) 17 (18.9) .04 0.8 (.681) Social 43 (17.2) 5 (2.8) 4 (4.4) .23 28.1 (<.001) Cognitive 7.5 (3.0) 10.5 (5.8) 0.5 (0.01)1 .10 5.2 (.074) Emotional 67 (26.8) 57 (31.5) 30 (33.3) .06 1.9 (.396) Development of competencies 13 (5.2) 2 (1.1) 3 (3.3) .10 5.3 (.071) Teaching 1 (0.4) 1 (0.6) 1 (1.1) .03 0.6 (.746) The service beneficiaries 22 (8.8) 11 (6.1) 16 (17.8) .14 9.9 (.007) Evaluation of the S-L project 36 (14.4) 28 (15.5) 10 (11.1) .04 1.0 (.621) Note: 1=Classroom Learning; 2=Personal Development; 3=Hospital Service. Values between brackets are percentages of quotes for each category. 1A constant value was added in each cell as recommended by Goodman (1970) for avoid prob- lems with empty cells in estimating chi-squared. Harmonia: Journal of Arts Research and Education 24 (1) (2024): 105-121116 addition, the artistic nature of the subject taught in the course can foster listener in- volvement, while musical expressiveness can improve connections with emotional responses and vice versa (Juslin, 2019). In this respect, Cespedes-Guevara and Eero- la (2018) suggest the existence of a shared acoustical-musical code for expressing ba- sic emotions. Moreover, the students affir- med that the service experience increased their self-esteem and self-confidence, coin- ciding with the results of the study by Tan- querel et al. (2018): the experience made them reflect about the meaning of life, one of the essential aspects of their personal development. On the other hand, for Per- sonal Development with respect to the preparation of the activity, in particular, the handling of frustration, nerves, and stress was a relevant aspect, which, in turn, can reflect the project’s degree of importance for the students. Students showed greater engagement and group effort, which is in line with the indications of Clayton et al. (2013), referring to the development of au- tonomy and responsibility for the students’ learning experience motivated by S-L. In the same vein as the study carried out by García and Lalueza (2019) on the subject of S-L, our study’s results show that the stu- dents acknowledge this methodology’s ca- pacity for training competencies: in a spe- cific, real-life context, curricular content can be applied via an appropriate realiza- tion of activities combined with effective problem-solving. Moreover, the process of training competencies (such as music performance and the adaptation of educational activi- ties to the evolutionary process of biologi- cal and psychological growth in children ages 0-6) can be associated with the deve- lopment of professional abilities in these teacher candidates. In this sense, Kovalev et al. (2016) indicate the need to develop professional competencies in preservice teachers, such as creative, communicati- ve, social, and personal abilities. The same authors argue that professional compe- tencies in future teachers are determined by the involvement of creative educators, capable of exerting a progressive influence on the spiritual renewal of society, human development, maintaining cultural tradi- tions, and producing innovative ideas (p. 4181). These contributions are in line with the aims of the project presented herein, as it is based on the idea that ethical and ci- vic competencies cannot be ignored nowa- days in the integral education of the indi- vidual (Delano-Oriaran et al., 2015; Hébert & Hauf, 2015). Regarding the impact of S-L on te- aching, the role and commitment of the professor is key in this type of methodo- logy, as it requires a rigorous prior orga- nization of the process, including holistic aspects that lie beyond the usual academic curriculum (Rodríguez-Izquierdo, 2018). The professors involved in this project felt called to be part of a personalized teaching process, in which they made a conscious decision to engage in innovative educa- tional strategies and assume the risks in- volved. Their commitment was to try to break away from traditional methodology and address the students’ global educatio- nal needs while providing a service to the community. Moreover, the social impact of S-L is relevant and tangible, as can be seen in the results. What is learned does not remain in the classroom but can provi- de benefits for society (Burton & Reynolds, 2009). The students involved in this project noted the emergence of group cohesion in the classroom as the project progressed; they reflected about problem-solving when faced with challenging tasks or difficulties in communicating among themselves. In those cases, students strived to reach joint agreements, which has not always been easy. They also tackled such difficulties by stating that the group’s diversity was an enriching social factor that could work in favor of productive collaboration. Results obtained in previous stu- dies also show the students’ high Perso- nal Growth score (Andrés-Romero et al., 2018). By getting to know the hospital environment, our university students felt encouraged to increase their degree of commitment and social responsibility. In Desirée García-Gil et al., Music for Hospitalized Children in Service-Learning: Academic 117 line with former studies, it seems that S-L projects such as this one can provide stu- dents with an enhanced understanding of the needs and problems of the community where they live (Essa-Hadad et al., 2015). As part of this process, the professor sought to assume the role of a guide for the students in their search for knowledge, their understanding of problem-solving, and their decision-making. This perspec- tive is addressed by Deeley (2016), who regards S-L as a critically oriented peda- gogy that fosters agency and empowers students to explore diverse possibilities on their own terms under guidance provided by the teacher. Apart from this, the profes- sor served as a mediator in the reciprocal flow of learning, as the recipients of the service perceived improvements and had a learning experience during the service. At the same time, those same recipients pro- moted a novel learning experience for the students who carried out the service. Bene- fits achieved in other S-L experiences make reference to this reciprocity: the benefit is indeed for all participants (Harwood & Ra- doff, 2009; Santos et al., 2018). In this way, the university collective (teachers and students) achieved a sense of belonging to a project of active citizenship in which a connection between learning and social reality was being sought. The S-L approach reinforced their sense of gra- titude and belonging to that collective. Ex- periences of this type enable participants to become much better acquainted with the real-life contexts and the true needs of service beneficiaries. This could not be achieved in the classroom alone, particu- larly in the case of initiatives like this one, which involves hospitalized children. This encourages a certain reciprocity between learning goals and service goals: the pro- ject benefits those who carry out the ser- vice and those who receive it (Ochoa & Pérez, 2019). The learning experience is therefore achieved in both directions. At the same time, taking the bene- ficiaries of S-L into account allows for a more holistic and realistic evaluation of the project (Puig et al., 2006), thereby opening up the possibility of developing future programs in which such benefits can be truly increased. In the present study we took family testimonials into account, sin- ce the children’s families were the actors most implied in the children’s overall de- velopment. Aramburuzabala and García (2013) point out that the need for the ser- vice should also be acknowledged as an aspect that should play a determining role in its effective evaluation. In the Evaluation category in referen- ce to co-evaluation, the qualitative results highlight peer assessments of competen- cy acquisition, referring to both academic and service learning (social and civic com- petencies). Deeley (2016) underscores the importance of summative co-assessment for the facilitation of a democratic appro- ach to learning that helps students master and articulate skills that are transferable to the workplace. In the same vein, Fol- gueiras (2019) stresses the importance of developing participatory and self-mana- ged assessment models with the purpose of enhancing students’ control over their own learning and motivation. The stu- dents’ perception of evaluation changed from regarding evaluation as a concern to understanding it as a support for learning. This change in their perception requires a change in the attitude of teachers towards evaluation: from presenting knowledge to promoting dialogue, from playing the role of ‘experts’ to understanding themsel- ves as ‘facilitators,’ thereby encouraging students to develop the necessary skills to evaluate their own work (Sicherl et al., 2017). The instruments we used for evalu- ation thus addressed the diverse aspects of intervention and learning. There is no unity in S-L previous research on the met- hod to be used to evaluate the experiences, even though S-L methodology requires a qualitative approach to ensure that re- searchers understand the complex social phenomena involved therein, although an incipient interest in the use of mixed rese- arch designs can be noted (Camilli et al., 2021). Our study was qualitative in nature, but our data analysis was complemented Harmonia: Journal of Arts Research and Education 24 (1) (2024): 105-121118 by a quantitative phase, which helped cla- rify our results. CONCLUSIONS It has been possible to solve pur- pose of this study: a) Students think that they have increased their academic deve- lopment (p. e. development of self-mana- gement of time and effort, autonomous planning, and self-assessment of the effort itself, skills related to the university course and the Early Child Education curriculum, including professional skills) and social development (p. e through their desire to participate actively in the hospital service). Also, b) social implications for the agents involved have manifested as the emergen- ce of group cohesion or sense of gratitude and belonging to that collective). According to results, this type of S-L experience has displayed the orga- nizational capacity to involve all agents concerned, so university faculty members seem to have transmitted content or skills that enable the students to complete a cour- se or a university degree, and more im- portantly, they are involved in educating students for life. This, in turn, transforms students’ perception of their personal identity and encourages them to exercise active citizenship. Social assistance outside the classroom is perceived as a positive act of generosity by the students, and leads to gratitude on the part of the beneficiaries in the hospital environment. ACKNOWLEDGMENT This research belongs to the Call for Projects of Learning Service at the Comp- lutense University of Madrid (UCM) 2018– 2019, by means of the Moving Music Pro- ject, Moving through Music (nº 17), carried out in Madrid Town Hall and sponsored by the Delegate of the Rector for Diversity and Environment of the UCM. 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