Data regarding year and country of publication (see Figure 2) showed that while there has been research in this area since at least 1995, most studies have been published in the last 10 years, with an trend towards increased publication of studies in recent years. Research has been concentrated in the US and to a lesser degree Australia. The only research paper published outside these two countries was undertaken in the Peoples’ Democratic Republic of Lao¹.

Programs overwhelmingly focused on “rap” as the primary medium (see Table 2), including lyric writing, analysis and exposure to “rap” songs or videos. The only other element reported as the program focus was “dance,”² yet it often shared this focus with “rap.” Four articles reported a more wholistic approach, centring three or more elements with explicit reference to Hip Hop culture. These were coded as using “culture” as a medium. Papers were also coded to explore the fields or disciplines in which studies were located. This considered factors such as journal, author affiliations, and key theoretical constructs used. Coding revealed studies were overwhelmingly located in the “public health” category (n =14; 63.64 %), and included a range of associated fields such as community health, health prevention, health promotion, health intervention, population and social health, sexual health, and violence prevention. Some also included authors or theories from neurology, substance use and environmental health. These studies tended to focus on health awareness interventions, where the focus was on educating students about various health issues. Three (13.64 %) studies were located in the field of education and tended to focus on educational interventions, while the studies located in the fields of social work (n = 3; 13.64 %) and school counselling (n1; 4.55 %) focused specifically on therapeutic interventions. One paper was located specifically in the field of theatre (4.55 %) yet described a community arts program intervention approach.

US programs were predominantly located in urban, inner-city, or low-income neighbourhoods in large cities, such as New York, Philadelphia, Los Angeles, Atlanta, and Boston. Some studies were also located in more metropolitan and suburban areas, yet there was no mention of regional, rural, or remote settings. Conversely, Australian studies were located primarily in remote Aboriginal communities and to a lesser degree in suburban/outer-suburban areas. The study in Lao was located primarily in the city centre of Savannakhet.

Programs were primarily described as located in secondary/high schools (n = 11), yet several were also in reported in primary/elementary (n = 5), and junior high/middle school settings (n = 5). Of these, four were reported as being charter (Akintobi et al., 2011; Lamb & Randazzo, 2016; Romero, 2012) or special schools for students with behavioural issues (Olson-McBride & Page, 2012). Seven studies reported programs that were run in classroom settings, four in counselling settings within schools, and the rest were either after school programs, or a combination of school and community settings.

Study participants were mostly adolescents (aged 13–18 years). Those in primary/ elementary schools typically included students of 9 years and above. Only one study included students from kindergarten age (Criss et al., 2016). Several studies included students over 18, up to the ages of 23 (Hill, 2009), and 25 (McEwan, Crouch, Robertson, & Fagan, 2013).

In US studies, participants were reported as being predominantly African American with several papers describing this as their main participant group (Akintobi et al., 2011; Gonzalez & Hayes, 2009; Hill, 2009; Lamb & Randazzo, 2016; Noble, Hedmann, & Williams, 2015; Olson-McBride & Page, 2012; Williams & Noble, 2008). Students of Latino or Hispanic background (including Mexican/Mexican-American; Romero, 2012) were the next most represented group, followed by white,³ and Asian students. Other cultural backgrounds described included Native American (Akintobi et al., 2011), Pacific Islander and “mixed heritage” (Sussman et al., 1995). Tucker et al. (1999) did not explicitly report the cultural backgrounds of their participant group, yet suggest in their introduction a focus on addressing issues related to “African American youths”, while Levy, Emdin, and Adjapong (2017, p. 3) described their participant group as “urban youth of color” (p. 3).

Australian studies located in remote communities reported their participants as being entirely (Crouch, Robertson, & Fagan, 2011; McEwan et al., 2013) or predominantly (Ennis, Clark, & Corfield, 2014) of Indigenous background – including Aboriginal and Torres Strait Islander. Another Australian study reported culturally and linguistically diverse participants, with a significant amount born in New Zealand, and speaking Samoan or Maori at home (Harris, Wilks, & Stewart, 2012). Cultural background was not reported in the other Australian study (Paukste & Harris, 2015). In the paper from Lao, participants were reported as being Laotian (Yoshida, Kobayashi, Sapkota, & Akkhavong, 2013).

Participants in at least 13 studies were reported as coming from low-socioeconomic backgrounds. With the exception of one study (Yoshida et al., 2013) all participant groups were described as coming from communities at risk in areas of health disparity, violence, school disengagement, family instability, behaviour problems, and poverty.

No studies explicitly reported non-binary or gender-diverse student participants. Of those reporting gender, most studies included a relatively even mix of male and female participants. Two studies reported only male participants (DeCarlo & Hockman, 2004; Gonzalez & Hayes, 2009) and another explained a disproportionate ratio of female (134) to male (37) participants, because "adolescent females are more readily involved in ‘artistic’ or group school activities than adolescent males" (Harris et al., 2012, p. 241).

The Health Awareness intervention approach was the most popular (n = 13; 59.1 %). This approach focuses on the use of Hip Hop to transmit health-related information to young people, and increasing their awareness of risk and protective factors around health issues. These studies were located entirely within the field of public health (and associated fields as described above), except one which was located within education (Lamb & Randazzo, 2016). Invariably, these interventions sought to address physical constructs of wellbeing. This included four sexual health programs, which used: rap videos to deconstruct and discuss narratives of rape culture (Lamb & Randazzo, 2016); analysis of lyrical content in popular rap videos to raise awareness around STIs (Boutin-Foster et al., 2010); lyric writing to augment a larger program promoting abstinence and positive sexual norms (Akintobi et al., 2011); and the creation, recording, and performance of rap songs promoting community-wide awareness of sexual health issues (Crouch et al., 2011).

Programs targeting aspects of healthy eating such as nutrition (Williams et al., 2016) and obesity (Criss et al., 2016; Romero, 2012) were also significant. Two of these took a wholistic approach to engaging Hip Hop, describing interventions which incorporated several aspects of the culture. For Williams et al. (2016) this involved transmitting information through Hip Hop culture-informed videos, cartoons, and rap songs. Similarly, Romero (2012) described use of breakdancing, graffiti, and rap writing workshops, as well as discussion of rap content and Hip Hop history to explore healthy eating themes. Another used video, song, and artwork creation to explore such themes, although the role of Hip Hop appeared less central (Criss et al., 2016).

Substance use was another focus, with one study using writing and performance of rap (amongst a number of tools) to raise awareness around risks of alcohol, tobacco, and other drug use (Paukste & Harris, 2015), while another used receptive viewing of rap videos to prevent smoking uptake (Sussman et al., 1995). Two interventions sought to increase community knowledge more generally in areas of neurological disorders: one using receptive listening to a tailored hip-hop song to increase awareness and recognition of stroke symptoms; the other using a combination of Hip Hop culture-informed music, dance, cartoons, and comics to increase health literacy around Alzheimer’s disease. Another explored the use of a rap music video, amongst other tools, to educate and expose students to the consequences of physical trauma for violence prevention (Tucker et al., 1999).

The only study investigating a Health Awareness approach, but not targeting a specific health construct, was Yoshida et al. (2013) who instead sought to develop and validate a scale which could determine the degree to which songs were able to communicate health promotion messages. This included a Laotian Hip Hop song, among two other traditional Laotian folk and strings-based songs.

Each of these studies focused on promoting awareness of health issues. Hip Hop was seen primarily as a tool to communicate information for this goal, and indicators of success included knowledge retainment and change in attitudes and beliefs. The connection between these programs and constructs of physical, rather than social or psychological, health was striking, and suggest a strong pattern in this area of research.

The Educational Intervention approach can be described as the use of Hip Hop-related activities in pedagogical-focused programs to improve wellbeing. Two of the 22 papers (9.09 %) reported these kinds of interventions, both of which described a strong focus on psychosocial wellbeing, including mental health and social connectedness.

While Health Awareness interventions undeniably include a strong focus on educating students, and may include pedagogical elements, several key factors differentiated these from Educational Interventions. Most significantly, instead of using Hip Hop to deliver health-related information to students with the hope of improving future health outcomes, Hip Hop was described here as providing a space for students to explore issues related to their own lives, and in doing so improve their wellbeing in the moment. Furthermore, unlike Health Awareness interventions, which were often delivered in classes related to the construct of health being addressed (i.e. physical or sexual education), Educational Interventions occurred in curriculum areas not immediately associated with the constructs of wellbeing addressed. For example, Hill (2009) described a program that used Hip Hop texts to teach English in the school curriculum, indicating its inherent pedagogical nature. Yet, by using this setting to analyze Hip Hop texts that themselves provided a “democratic space,” teachers were able to facilitate a space where students could explore their own narratives of pain, suffering, and injustice. This enabled students to share and connect with others with similar stories, express themselves, and form a sense of community.

Emdin, Adjapong, and Levy (2016) report on the benefits of a science program that used the composition of raps for “engaging in and with rigorous science content” (p. 308). While a primary intention and outcome of this program was to support student learning in the science curriculum, authors reported that through the act of writing and reflecting on their rhymes, students were able to express aspects of their life experiences and become more connected with their emotions. Again, conscious facilitation by teachers enabled a space where students could foster a sense of agency and social connection with their teachers and each other. They described this as “the merging of the ‘first space’ of traditional STEM education and the ‘second space’ of mental health/counseling to create a third space where urban youths can release tensions that result from trauma they experience” (p. 310). These examples suggest that Educational Interventions depend less on the nature of the information being delivered and more on the spaces facilitated by teachers for students to engage with Hip Hop as a way to process their own experiences.

Studies identified as taking a Community Arts Programs approach were characterized by interventions which were described as embedded within, delivered by, or closely linked with the wider community. Furthermore, it was not only the facilitation of the program that included the wider community, but benefits were also often intended to extend beyond the student participants to their respective communities. Three of the 22 (13.6 %) programs were identified in this category, all were located in Australia, and all involved a range of performing arts modalities to engage community.

Ennis et al. (2014) described a project that used theatre and music workshops to undertake what was described as a community development project. While this included a primary focus on supporting student confidence, self-esteem, and school engagement, it also aimed to create lasting relationships between schools, students, the local community, and community-based arts organizations. While the program included arts activities not related to Hip Hop (such as dance), the creation and production of Hip Hop songs (beats and lyrics) which were shared through music videos and performances were central. These were said to give Indigenous youth a voice in their communities and create connection between different social groups.

McEwan et al. (2013) described a similar project that included the creation and performance of Hip Hop dances and songs with Indigenous youth. While the primary goal was to promote sexual health, it involved other key aims and outcomes including “event-specific community mobilisation [and laying] important groundwork to progress school-based and community mechanisms to address regional youth disadvantage” (p. 132). Thus, while the project aimed to achieve immediate health outcomes, there was an equivalent focus on developing the capacity of the community to address health issues in the future. Authors described a specific focus on exploring the use of arts to facilitate community-driven approaches to address health issues, as an alternative to clinical interventions.

The program described by Harris et al. (2012) focused on the use of dance to address students’ psychological, social, and physical wellbeing. Again, a central tenet of this program was to facilitate positive community connections. While students worked on their dances within school settings, final performances held between participating schools and in local community settings offered them ways to engage in “positive social activities within their community” (p. 239). Along with a range of more individual wellbeing outcomes related to physical health and confidence, students also reported stronger social ties in their district communities. This included positive connection to peers, their schools, and through collaboration and public performances, other schools, local institutions, family groups, and community more generally. These examples suggest a project-based intervention approach which uses Hip Hop activities carried out in community settings to not only address individual wellbeing but also to develop stronger communities.

Programs identified as Therapeutic Interventions were unique in their use of Hip Hop specifically as a therapeutic tool. Four of the 22 (18.2 %) studies made up this category, all of which were located in therapeutic-related fields, such as social work or school counseling, and focused specifically on addressing psychosocial or mental health. Unlike the other approaches, these programs were delivered by qualified mental health professionals in controlled settings typically deemed appropriate for addressing and processing significant psychosocial or mental health issues. With the exception of one (Levy et al., 2017), all programs focused on the use of rap as a therapeutic tool.

For example, Olson-McBride and Page (2012) described a “specialized poetry therapy intervention that incorporated hip-hop and rap music with high-risk youths” (p. 124). While this program involved a poetry/creative writing element, the authors reported a significant focus on using analysis and discussion of popular rap songs to facilitate participants’ self-disclosure of significant or traumatic life events, fears, fantasies, and relationship issues.

Gonzalez and Hayes (2009) described a school counseling intervention that is based on Elligan’s (2004) model of Rap Therapy. Here a student’s personal interpretation of lyrics and messages in rap songs were used to explore associations with their own thought patterns, emotions, and risky behaviours. Through facilitated discussion of these associations in the larger context of rap music, the counselor worked with the students to reframe anti-social or risky thoughts and behaviours. This intervention involved roleplay, as well as composition of rap lyrics, to explore more constructive thought processes as well as to express and process personal struggles.

DeCarlo and Hockman (2004) described an intervention where three groups of young men (one of violent offenders, one of status offenders, and one of non-offenders) analysed lyrics from popular rap songs to develop prosocial behaviors around “female gender abuse, anger management, impulse control, reasoning, morality, responsibility, [and] identity” (p. 52). While authors referred to this as psychoeducation program in the article, this program was categorized as a Therapeutic Intervention as it was otherwise described specifically as a therapy program, delivered by a trained clinical social worker in a therapeutic setting, and involved group processing of sensitive topics like those above.

The program described by Levy et al. (2017) extended beyond a focus on rap, and centred instead on the concept of a “hip-hop cypher,” which they described as “highly codified yet unstructured practices where youth who identify with hip-hop culture information exchange in the form of raps or dance” (p. 2). Here, while students engaged in a social work group program that involved DJing, writing raps, making beats, and recording full tracks, the concept of the hip-hop cypher was described as the central element, with the key social norms of the cypher used to help structure group sessions. These included,

These sessions aimed to “enable students the opportunity to express and explore a multitude of emotional obstacles they were facing” (p. 3), while also allowing opportunities for them to form social support structures and community.

As these examples show, Therapuetic Intervnetions are more likely to target significant emotional, social and mental health issues of individuals, in a theraputic format. They also position themselves as largely separate from the mainstream curriculum and can be seen as less focused on community-wide engagement in order to allow more focus on addressing the issues affecting young people in the moment.

Wellbeing benefits reported in relation to Health Awareness interventions related primarily to health promotion, observed chiefly in terms of increased student awareness of health issues and conditions. This included increased knowledge of the symptoms and causes of Alzheimer’s Disease (Noble et al., 2015) and stroke (Williams & Noble, 2008), as well as the risks and choices related to sexually transmitted infections (STI) (Boutin-Foster et al., 2010). Akintobi et al. (2011) also reported a significant increase and retainment of student knowledge and understanding of the risks of sex, benefits of abstinence, as well as associated refusal skills and goal setting strategies.

Other studies also reported changes in attitude in behaviour. Paukste and Harris (2015) related their program was not only successful in engaging and informing hard to reach youth about the risks of substance abuse, it was also observed to change attitudes to use. Lamb and Randazzo (2016) stated the sexual ethics program they investigated successfully changed anti-woman and rape-conducive beliefs, as shown by significant positive changes on measures of rape myth beliefs and intent to act ethically on behalf of victims. Tucker et al. (1999) reported modest benefits in students’ ability to retain information related to physical trauma, identify violence as a problem, and the deterrence of future violence. Williams et al. (2016) reported more specific changes in health-related behaviour, as demonstrated by a mean decrease of 20 % in the students’ purchase of high-calorie or unhealthy foods. Romero (2012) reported a wider range of benefits, including significant increase in vigorous, physical activity, increased self-esteem among girls, and decreased perceptions of neighbourhood-related health barriers for boys.

Some studies described engagement as a primary outcome. Criss et al. (2016) reported their media-competition program for the dissemination of obesity-related information showed a high adoption rate among schools (school 1, 100 %; school 2, 39 %), and notable student reach (school 1, 30 %; school 2, 13 %). The performing arts program investigated by Crouch et al. (2011) was found effective in engaging both students and community members in exploring and discussing physical, emotional, and sexual health related issues and in developing strategies to address them. However, several studies in this category reported no benefits. For example, Sussman et al. (1995) found no observable benefits of a Hip Hop video on “intention to smoke” or “trial of smoking” measures, while students in Yoshida et al.’s (2013) reported a Hip-Hop song less effective in communicating health messages than two traditional Laotian songs.

As mentioned above, studies of Educational Interventions reported benefits in the areas of psychosocial wellbeing and mental health. However, in both cases, these were described as linked to regular classroom practice.

For Hill (2009) benefits centred on disclosure and the concept of “healing” which,

Specific benefits included self-expression and connection with others through narratives around pain, loss, marginalization, and inequity. This led to the ability to share and process experiences of pain and suffering and the formulation of a community, which provided social support and cohesion. Notably, Hill reported this did not benefit their wellbeing in isolation from the educational setting, but also helped students and teachers imagine new, culturally relevant possibilities for engaging in classroom spaces.

Emdin et al. (2016) also reported mental health benefits in connection to classroom practice and learning. These benefits included students’ ability to gain deeper knowledge of themselves by engaging with, expressing, and sharing issues they face in their daily lives through lyric composition. In doing so, they were able to voice their emotions, and become more socially connected to others. Teachers were also able to gain insight into the socioemotional sides of their students. Authors reported educational benefits as inextricable from these emotional benefits; not only did their lyrical compositions contain science content, but they could re-imagine their identities as science students in positive ways.

Benefits of Community Arts Programs interventions emerged as representing a mix between individualised psychosocial benefits, as well as broader community-related social outcomes. For example, while Harris et al. (2012) reported more individualized outcomes, including self-expression the ability to participate in positive life experiences, the socially-focused outcomes were significant. This included observed co-operation, social solidarity, and connectedness with school community. Similarly, while McEwan et al. (2013) reported increased awareness among students, own knowledge of sexual health and social disadvantage, benefits such as increased social connection, and social change in the form of community mobilization around sexual health issues were prominent.

Ennis et al. (2014) also reported both personal and social benefits. Personalised benefits included reduced shame and increased sense of pride, confidence, self-esteem, and school engagement. The provision of a uniquely safe space also facilitated social, connection, cohesion, and inclusion between different socioeconomic and ethnic groups, while the program in general facilitated students’ connection to schools and the local community.

Studies of Therapeutic Interventions consistently reported profound psychosocial wellbeing outcomes. These centred on self-expression, catharsis, meaningful social connection, and self-management of emotions and behaviours. Levy et al. (2017) reported their counselling program provided students a space which offered a sense of safety and belonging, allowing students to create positive and cohesive group norms and ways of being together that were communal, open, and accepting. This space promoted self- and emotional-expression, and connection via sharing personal narratives. This offered opportunities for catharsis, and when combined with the established respectful and supportive environment, allowed students to unite, connect and affirm each other through mutual social support. A further outcome was that students became more open to counselling processes.

Gonzalez and Hayes (2009) described a young person who gained a broader understanding of rap music and re-assessed their connection with risky or anti-social lyrical content. Through writing and discussing their own raps, they were able to express, externalise, and process life experiences. This process allowed them to recognise and acknowledge their own anger and negative behaviours, and learn how to manage them in positive ways.

For Olson-McBride and Page (2012), benefits related primarily to self-disclosure through shared opportunities for prosocial interaction. While rates of self-disclosure often fluctuated, given students’ perceived need to protect themselves from harm, exploration of song lyrics precipitated deeply personal discussions around individuals’ thoughts and feelings. These discussions facilitated meaningful self-expression and prosocial relationships between group members. Authors described this as “therapeutic self-disclosure and connection”, which not only allowed them to become more aware of each other, but also themselves.

DeCarlo and Hockman (2004) reported students’ preference for a “RAP therapy” program over a psychoeducational program that contained no Hip Hop content. DeCarlo and Hockman go on to report those participating in the RAP therapy program showed better engagement during sessions and prosocial skills development than those in the psychoeducational program. Benefits in prosocial skills were most pronounced in areas of anger management; delinquent behaviour; impulse control; female gender abuse; moral development; decision making; social relations; and relatedness to daily life situations.

Studies in the Therapeutic Interventions category align most closely with music therapy practice. Thus, benefits reported here indicate the value of working through or with Hip Hop in school-based music therapy programs.

Authors took several different approaches to describing Hip Hop in the reviewed articles. These descriptions emerged under three categories; Hip Hop as Culture, Hip Hop as Genre or Activity, No Formal Description.

Rationales for using Hip Hop centred primarily on cultural relevance and ability to engage particular youth. In Australia, this included engaging low-socioeconomic and diverse youth in health promotion through an age appropriate (Crouch et al., 2011) and “culturally familiar milieu” (Harris et al., 2012, p. 239; Paukste & Harris, 2015). US authors presented similar arguments, yet often drew more nuanced or developed connections. These inevitably included a desire to engage African American, Latino, or youth of Colour, given these populations are frequently exposed to the worst health stressors, yet are the least engaged with mainstream services or institutions (Levy et al., 2017) often because they represented or enacted oppression of these groups (Emdin et al., 2016; Hill, 2009). Many authors drew upon concepts and terms such as “culturally sensitive” (Sussman et al., 1995), “culturally targeted” (Williams et al., 2016), “culturally relevant” (Boutin-Foster et al., 2010) or “culturally appropriate” (Williams & Noble, 2008). Some talked about the importance of creating links between students and facilitators in terms of providing “culturally similar role models” (Romero, 2012), “culturally sensitive instructors” (Akintobi et al., 2011), or using Hip Hop to “bridge cultural gaps” between students and facilitators (DeCarlo & Hockman, 2004; Gonzalez & Hayes, 2009). For music therapists that aim to use client-preferred music, it would seem that Hip Hop-informed programs provide an important way to connect with certain populations.

For others, Hip Hop presented opportunities to nurture “critical consciousness and activism” around topics of power, identity (Hill, 2009, p. 248) and discrimination (Romero, 2012), thus empowering students who may otherwise feel powerless in education contexts (Gonzalez & Hayes, 2009). This often involved repositioning discourse and interventions within the context of students’ daily lives and experiences (DeCarlo & Hockman, 2004). Such authors drew on concepts like “critical pedagogy” (Hill, 2009), “reality pedagogy” (Emdin et al., 2016), as well as Hip Hop-specific theories, such as “critical Hip Hop pedagogy” (Romero, 2012), “Hip Hop-centered pedagogy,” “hip-hop based education” (Hill, 2009, p. 248), “Hip Hop Therapy” (Olson-McBride & Page, 2012) or “Rap therapy” (Gonzalez & Hayes, 2009).

Some authors argued Hip Hop was used because the stylistic qualities of the music and dance (speed and strong beats) promoted learning outcomes (Noble et al. (2015). In contrast, several papers offered no clear rationale for the inclusion of Hip Hop. Of these, McEwan et al. (2013) stated simply the success of previous Hip Hop programs, while the rest made no mention of why Hip Hop was included, (Criss et al., 2016; Lamb & Randazzo, 2016; Tucker et al., 1999) or of Hip hop at all (Ennis et al., 2014).

Several accounts were offered for the relationship between Hip Hop and wellbeing. For many, Hip Hop provided a unique and culturally relevant “vehicle” or “medium” to deliver content (Boutin-Foster et al., 2010; Williams et al., 2016) or engage young people in an intervention or program (Harris et al., 2012; Paukste & Harris, 2015). Here, while playing an important role, Hip Hop was sometimes considered to “supplement” (Williams & Noble, 2008) the main intervention, which itself may not be directly related to Hip Hop culture. While many papers made compelling arguments regarding cultural relevance, they often positioned Hip Hop as a way to make health interventions more palatable or retain participation in other elements of a program (Akintobi et al., 2011). While such positions suggest Hip Hop has value in engaging youth in health interventions, we argue here that interventions taking this approach risk trivialising Hip Hop culture by relegating its role to a sweetener for the real work. These approaches may also be seen to support cultural appropriation.

Several articles described Hip Hop as not just a way to deliver content or engage students in healthy practices but as the origin of content or practices that themselves fostered wellbeing. This included identifying and promoting healthy behaviours and practices (such as breaking) within Hip Hop culture, and acknowledging that this culture involves critical engagement with narratives of social justice and awareness of the impact of privilege and discrimination (Romero, 2012). All authors reporting on therapeutic interventions also positioned Hip Hop as offering an alternate mode of being in the world (or therapeutic space) that connected with and valued the culture, identity, and socio-political reality of students (DeCarlo & Hockman, 2004; Emdin et al., 2016). For Levy et al. (2017), this positioning meant offering students an alternative way to address mental health, given established approaches are rooted in, or founded upon, world views that traditionally exclude them. Gonzalez and Hayes (2009) extended on this notion, suggesting approaches that acknowledge and forefront students’ affiliation and skills in Hip Hop (i.e. rapping) can reposition them as experts in a therapeutic relationship and “allow students to regain power in a situation where they may feel powerless” (p. 169). For Hill (2009), the texts of Hip Hop culture themselves (i.e. song lyrics) fostered student wellbeing, as they offer narratives that were more real, or reflective of students’ own experiences where they could both see themselves and also connect to those around with similar narratives. Olson-McBride and Page (2012) extended on these ideas, suggesting Hip Hop texts allow students to engage in therapeutic work using their language, rather than the language of psychotherapy, which is unfamiliar to them. In all of these cases, Hip Hop provided not just a vehicle but a world view that acknowledged students’ identity and empowered them to become agents in their own healing. These examples point to the wider value of engaging in Hip Hop as a therapist; not only does it provide a way to engage clients, it provides a unique space familiar to many young people in which they can engage in wellness work.

Several papers also highlighted the importance of involving artists and other members of the Hip Hop community to help develop (Sussman et al., 1995) and deliver content (Williams & Noble, 2008) to ensure a level of authenticity. Involving active members of the Hip Hop community was also reported important for providing culturally relevant role models to reframe health behaviour norms (Romero, 2012; Williams et al., 2016). For Paukste and Harris (2015), learning from recognised Hip Hop artists was the key factor, as students were less involved when “rap artists” were not present. We argue that this illustrates both a potential challenge and opportunity in this area. These findings caution against the delivery of Hip Hop-informed programs without including members of the Hip Hop community. While the articles reviewed here discussed this concept specifically in relation to outcomes, we also caution that programs without a genuine connection to Hip Hop culture could not only appear inauthentic to clients but also risk cultural appropriation. Thus, we argue these findings clearly identify the value of engaging members of the Hip Hop community in any therapeutic program, either as co-facilitators, or at the very least, as paid consultants.

Some authors stated the particular stylistic attributes of Hip Hop supported wellbeing. Romero (2012) described the aerobic capabilities and strength necessary for breaking as beneficial for physical health, while Noble et al. (2015) suggested the call and response in rap helped reinforce concepts. Paukste and Harris (2015) suggested the “flow,” or the interaction between rap lyrics and the rhythm of the beats, helped students engage with content in ways that other activities could not as they were considered undynamic, or “staid.” Many papers provided minimal (Ennis et al., 2014) or no discussion of how Hip Hop led to outcomes (Criss et al., 2016; Crouch et al., 2011; Tucker et al., 1999).

Ten of the 22 papers focused on quantitative methods; nine of which were investigating a Health Awareness intervention and one which was investigating a Therapeutic Intervention. Sample sizes ranged from 21 (DeCarlo & Hockman, 2004) to 717 (Sussman et al., 1995) students, with a mean of 228.55 across the 10 studies. Six studies used a pre-post design to measure change in their chosen construct of wellbeing (Lamb & Randazzo, 2016; Noble et al., 2015; Romero, 2012; Sussman et al., 1995; Williams et al., 2016; Williams & Noble, 2008). The other four collected data at one time-point only to assess constructs such as information retention (Tucker et al., 1999), program reach (Criss et al., 2016), song perception (Yoshida et al., 2013), affective response, prosocial skill acquisition, and preference for intervention method (DeCarlo & Hockman, 2004).

Only four studies used a control or comparison group, while just half reported use of validated measures. While most papers stated at least some study limitations, several did not, and the reporting of standard statistical information, such as significance, was not consistent among studies. This information suggests that while quantitative methods have been used most consistently, there is a notable lack of studies in this area reporting with the methodological rigor typically expected of quantitative research.

Eight studies took qualitative approaches, including one ethnography (participant observation) with clear theoretical positioning and discussion of data collection (Hill, 2009). Another described a similar approach, yet also included interviews, artefacts, and clear positioning and transparent reporting of data collection and analysis (Emdin et al., 2016). Another used interviews and open ended surveys, and while the theoretical positioning was more basic, the methodology was clear and transparently reported (Harris et al., 2012).

Three papers reported program evaluations rather than research (Boutin-Foster et al., 2010; Ennis et al., 2014; McEwan et al., 2013). While these provided little to no detail on theoretical positioning, each provided notable detail on the methods and procedures. Two papers presented case studies or reflections on their work (Gonzalez & Hayes, 2009; Levy et al., 2017). These papers were less focused on reporting research outcomes, and rather used vignettes or observations to support the presentation of particular program approaches.

The diversity in methodological rigor in these papers can largely be explained by the inclusion of published evaluation and case illustration papers in the review. For those that did take a research approach, reporting was of a high quality.

Four papers reported a combination of qualitative and quantitative-style approaches. One used focus groups and surveys to evaluate the impact of an intervention on changing attitudes to rape culture (Akintobi et al., 2011). While, again, this was an evaluation, descriptions for both processes of data collection and analysis were detailed and transparent, and measures were validated. Another studycoded video footage for instances of disclosure during therapy for quantitative analysis which compared two groups (Olson-McBride & Page, 2012). These tapes were coded twice by two different people to check interrater reliability, and results were supported by interview data. Reporting was again clear and transparent.

Two papers reported evaluation-style approaches. One used observation data, focus groups, semi-structured interviews and a survey to evaluate impact of substance-use awareness program. Only descriptive statistics and basic thematic analysis were reported, although some description of methods was provided (Paukste & Harris, 2015). The other used attendance data, testimonials, and what seemed like anecdotal data to assess the impact of sexual health workshops (Crouch et al., 2011). There was little to no discussion of data collection and no mention of analysis.

Again, the quality in these studies varied greatly, potentially due to the evaluative approach of the last two. Yet, while the first two reported reasonably rigorous studies, none of the four papers located themselves clearly in the methodological literature. The absence of engagement with discourse on mixed methods research was particularly notable, as was lack of discussion about how and when data from different approaches was combined.