Communication difficulties in adults with Intellectual Disability: Results from a national cross-sectional study

BACKGROUND

People with an intellectual disability (ID) are vulnerable to communication impairments, with consequences for employment, education, and social participation.

AIMS

To identify the communication skills of a population of adults (40+ years) with ID and explore relationships between individual and environmental factors and communication skills.

METHODS AND PROCEDURES

Data from a sample of 601 adults with ID was selected from the Intellectual Disability Supplement to The Irish Longitudinal Study on Ageing (IDS-TILDA) addressing communication characteristics, demographics, co-morbidities, challenging behaviours, and social participation. A multiple regression model and a decision-making tree were built to identify factors related to communication abilities.

OUTCOMES AND RESULTS

Overall, 57.9 % of participants experienced communication difficulties, with 23.5 % reporting severe difficulties. Only 75.1 % of participants communicated verbally; more than half found communicating with professionals and non-familiar partners difficult. Level of ID, low social participation, challenging behaviours, and diagnosis of Down syndrome were significantly associated with communication difficulties.

CONCLUSIONS AND IMPLICATIONS

Communication difficulties are prevalent in adults with ID and are influenced by complex factors. Interventions to enhance interaction and quality of life of individuals with ID should consider communication opportunities, needs, and barriers.

Study protocol of the Healthy High School study: a school-based intervention to improve well-being among high school students in Denmark

BACKGROUND

The prevalence of low well-being, perceived stress and unhealthy behaviours is high among high school students, but few interventions have addressed these problems. The aim of this paper is to present a study protocol of a cluster randomised controlled trial evaluating the Healthy High School (HHS) intervention programme. The intervention programme is designed to improve well-being (primary outcome) by preventing 1) stress and promoting 2) sleep, 3) sense of community, 4) physical activity (PA) and 5) regular and healthy meals among high school students in Denmark.

METHODS

The development of the HHS study was guided by the Intervention Mapping protocol. The intervention comprises four components: 1) a teaching material, 2) a smartphone app, 3) a catalogue focusing on environmental changes, and 4) a peer-led innovation workshop aiming at inspiring students to initiate and participate in various movement activities. The HHS study employs a cluster-randomised controlled trial design. Thirty-one high schools across Denmark were randomly allocated to intervention (16 schools) or control (15 schools) groups. The study included all first-year students (~ 16 years of age) (n = 5976 students). Timeline: Intervention: August 2016 - June 2017. Collection of questionnaire data: Baseline (August 2016), 1st follow-up (May 2017) and 2nd follow-up (April 2018). All students were invited to participate in a monthly sub-study about perceived stress using text messages for data collection (September 2016 - June 2017). PA was objectively assessed among a sub-sample of students using accelerometers (Axivity, AX3) in August 2016 and May 2017.

PRIMARY OUTCOME MEASURES

Student well-being measured by the Cantril Ladder and the five item World Health Organisation Well-being Index (individual level outcomes).

SECONDARY OUTCOME MEASURES

Stress (10-item Perceived Stress Scale), sleep (quantity and quality), PA (hours of moderate-to-vigorous PA per week, hours of daily sedentary time and average daily PA), meal habits (daily intake of breakfast, lunch, snacks and water), and strong sense of community in class and at school, respectively (individual level outcomes). The study encompasses process and effect evaluation as well as health economic analyses.

TRIAL REGISTRATION

ISRCTN ISRCTN43284296, 28 April 2017, retrospectively registered.

'Good health means being mentally, socially, emotionally and physically fit': women's understanding of health and ill health during and after pregnancy in India and Pakistan: a qualitative study

OBJECTIVE

To explore what women consider health and ill health to be, in general, and during and after pregnancy. Women's views on how to approach screening for mental ill health and social morbidities were also explored.

SETTINGS

Public hospitals in New Delhi, India and Islamabad, Pakistan.

PARTICIPANTS

130 women attending for routine antenatal or postnatal care at the study healthcare facilities.

INTERVENTIONS

Data collection was conducted using focus group discussions and key informant interviews. Transcribed interviews were coded by topic and grouped into categories. Thematic framework analysis identified emerging themes.

RESULTS

Women are aware that maternal health is multidimensional and linked to the health of the baby. Concepts of good health included: nutritious diet, ideal weight, absence of disease and a supportive family environment. Ill health consisted of physical symptoms and medical disease, stress/tension, domestic violence and alcohol abuse in the family. Reported barriers to routine enquiry regarding mental and social ill health included a small number of women's perceptions that these issues are 'personal', that healthcare providers do not have the time and/or cannot provide further care, even if mental or social ill health is disclosed.

CONCLUSIONS

Women have a good understanding of the comprehensive nature of health and ill health during and after pregnancy. Women report that enquiry regarding mental and social ill health is not part of routine maternity care, but most welcome such an assessment. Healthcare providers have a duty of care to deliver respectful care that meets the health needs of women in a comprehensive, integrated, holistic manner, including mental and social care. There is a need for further research to understand how to support healthcare providers to screen for all aspects of maternal morbidity (physical, mental and social); and for healthcare providers to be enabled to provide support and evidence-based care and/or referral for women if any ill health is disclosed.

[Follow-up of Post-Transitional Housing for Homeless Women: Needs, Implementation and Outcomes of a Pilot Study]

Objectives Consolidation of supported housing policies is a primary source of solutions aimed at addressing the problem of homelessness. Transitional housing (TH) offers a sequential housing trajectory from emergency shelters, to TH, to permanent housing with or without supports. Post-TH follow-up may improve residential stability and community integration. Yet little information is available on successful conditions and effectiveness related to post-TH follow-up for improving residential stability and community integration among homeless people, and especially homeless women. This pilot case study aimed to identify the needs of women who were previous TH residents before acquiring permanent housing with supports, the implementation process for post-TH follow-up activities and intensity of services offered and conditions for success of the follow-up, as well as the outcomes of post-TH follow-up in meeting the needs of these homeless women. Methods Two non-profit organizations for housing reintegration in the Montreal area were selected for study. Mixed methods based on a case study approach were used, triangulating the data collected from homeless women, case managers, and housing managers. Two interviews were conducted at 6-month intervals with homeless women (n=10), whose needs and outcomes related to post-TH follow-up were identified through a questionnaire with open and closed questions. To document implementation of the post-TH follow-up, case managers (n=2) recorded information on follow-up activities and intensity of services offered for the 6-month period using contact sheets. Factors facilitating and hindering post-TH follow-up were also identified in a group interview with case managers (n=2) and resource managers (n=4). Results Users identified health maintenance, support for daily activities and improved socialization as their primary needs. Most women were satisfied with activities offered and the frequency of follow-up, ease of access to case managers, and the overall capacity of follow-up to meet their needs. The intensity of follow-up, user/case manager therapeutic alliance, and user motivation to recover were identified as facilitating factors that influenced effectiveness of post-TH follow-up. Factors that hindered effectiveness included: the limited duration of TH before post-TH follow-up particularly among users with major trauma; refractory behavior; reluctance to take medications and consumption of psychoactive substances; problems in accessing health services, particularly specialized mental health services; and for case managers: time constraints, logistical difficulties related to follow-up, and lack of affordable permanent housing adequate to user needs. After six months, 80% of users remained in their housing and no changes were identified in community integration. Conclusion Post-TH follow-up seems particularly adapted to promote residential stability among chronically homeless women with mental health or dependence issues, as the essential first step toward community integration. The study underlined the importance of offering multiple service modalities adapted to user needs and post-TH follow-up geared toward recovery. Better funding of post-TH follow-up, tighter collaboration with other public services, case manager training, and increase in affordable and adequate permanent housing would promote more effective deployment of post-TH follow-up.

Participating in a new group and the identification processes: The quest for a positive social identity

Immigrants experience identity shifts; they can identify with the new cultural group and, sometimes, identify less with their group of origin. Previous research suggests that participation in the new cultural group predicts these two identity shifts. However, these studies have exclusively used correlational methodologies. Furthermore, previous research ignored that when a group is negatively valued, individuals may not identify with it, even after participating in it, to preserve a positive social identity. This article tests with an experimental methodology whether participation recreated the identity shifts previously identified (greater identification with the new group and lower identification with the group of origin when perceiving dissimilarity). Furthermore, it tested how a group's value impacted these identity shifts following participation. Immigrants in Quebec (N = 184) either participated in Quebec's culture (watched hockey) or did not (watched basketball). Quebec's value was manipulated by changing whether Quebec won, tied, or lost the game. Compared to watching basketball, watching Quebec's team win or tie showed the hypothesized identity shifts, illustrating the importance of the new group's value when participating.

Permanent education as an inalienable responsibility of health councils: the current scenario in the Unified Health System

OBJECTIVE

To verify whether health councils in Brazil carry out permanent education activities for municipal, state and federal district councilors.

METHOD

This was a cross-sectional study with secondary data collection in the Health Council Monitoring System (Sistema de Acompanhamento dos Conselhos de Saúde - Siacs) from May to August 2017. The Siacs is publicly accessible and available on the internet. It provides data from thousands of health councils throughout Brazil. Analysis and interpretation of the data were based on the literature and the enacted legislation, particularly Resolution 453/2012 and the National Policy of Permanent Education for Social Control in the Unified Health System (Política Nacional de Educação Permanente para o Controle Social no Sistema Único de Saúde).

RESULTS

Despite the fact that Resolution 453/2012 establishes the deliberation, elaboration, support and promotion of permanent education for social control as functions of the councils (in accordance with the guidelines of the National Policy of Permanent Education), approximately 40% of councils do not carry out permanent education.

CONCLUSIONS

It is necessary to strengthen the role of health councils in the elaboration of educational initiatives across the national territory. This includes the allocation of financial resources to increase access to and participation in these initiatives, which would strengthen social control in the Unified Health System. This study emphasizes that the discussion of permanent education is not given sufficient attention in the agendas and routines of health councils. This compromises the effectiveness of councils' monitoring and deliberation of public health policy.

Teenage predictors of participation of adults with cerebral palsy in domestic life and interpersonal relationships: A 13-year follow-up study

BACKGROUND

Adults with cerebral palsy (CP) may experience problems with participation in domestic life and interpersonal relationships.

AIMS

To identify teenage predictors of adult participation in domestic life and interpersonal relationships.

METHODS AND PROCEDURES

This 13-year follow-up of the PERRIN 16-24 cohort included 53 adults with CP without intellectual disability [current age 31.7 (SD = 1.4) years]. Participation performance was assessed as attendance (Vineland Adaptive Behavior Scales), and difficulty/assistance with participation (Life Habits questionnaire). 56 teenage factors were categorized in ICF components. Stepwise multiple linear regression analyses explored predictors of participation.

OUTCOMES AND RESULTS

Lower gross motor capacity, following special education, having protective parents and a rigid personality predicted less participation in domestic life. Having rejective parents, receiving little daily support, having a socially avoidant personality or coping style and the male gender predicted less participation in interpersonal relationships. Lower activity and participation levels as a teenager predicted less participation in both domestic life and interpersonal relationships of adults with CP.

CONCLUSIONS AND IMPLICATIONS

Environmental and personal factors, gross motor capacity and teenage participation were predictors of participation of adults with CP. These factors help identify subgroups at risk for suboptimal adult participation and provide targets for rehabilitation.

The Epidemiology of Social Isolation: National Health and Aging Trends Study

OBJECTIVES

Social isolation among older adults is an important but under-recognized risk for poor health outcomes. Methods are needed to identify subgroups of older adults at risk for social isolation.

METHODS

We constructed a typology of social isolation using data from the National Health and Aging Trends Study (NHATS) and estimated the prevalence and correlates of social isolation among community-dwelling older adults. The typology was formed from four domains: living arrangement, core discussion network size, religious attendance, and social participation.

RESULTS

In 2011, 24% of self-responding, community-dwelling older adults (65+ years), approximately 7.7 million people, were characterized as socially isolated, including 1.3 million (4%) who were characterized as severely socially isolated. Multinomial multivariable logistic regression indicated that being unmarried, male, having low education, and low income were all independently associated with social isolation. Black and Hispanic older adults had lower odds of social isolation compared with white older adults, after adjusting for covariates.

DISCUSSION

Social isolation is an important and potentially modifiable risk that affects a significant proportion of the older adult population.

Social Participation Facilitators and Barriers Among Older Adults Residing in Assisted Living

BACKGROUND

Assisted living facilities are a housing option commonly used for aging adults to promote independence and successful aging. As the older adult population increases, so will the population of older adults residing in assisted living facilities.

OBJECTIVE

To identify the facilitators and barriers to social participation among a cohort of older adults residing in an assisted living facility.

METHODS

The qualitative study employed a phenomenological approach using semi-structured interviews. Using convenience sampling, 20 older adults residing in an assisted living facility took part in the study. The research team transcribed the audio recording verbatim following each interview and conducted a line-by-line analysis using concept coding to identify emerging themes.

RESULTS

Themes involving factors serving as facilitators to social participation included health benefit, camaraderie, and resilience. Themes related to barriers to social participation included health limitations, lack of meaningful activities, and adapted activities.

CONCLUSION

The study provides insight into the facilitators and barriers impacting social participation for older adults residing in an assisted living facility. Study findings support the need for an increased presence of occupational therapy services in assisted living facilities.

Women's bargaining power and child feeding in Nepal: Linkages through nutrition information

Women's intra-household bargaining power is an important determinant of child nutritional status, but there is limited evidence on how it relates to infant and young child feeding (IYCF) practices. We conducted a cross-sectional analysis using 2012 baseline data from the impact evaluation of Suaahara, a multisectoral programme in Nepal, focusing on households with children 0-23 months (n = 1787). We examined if women's bargaining power was related to exposure to IYCF information and if exposure to IYCF information was in turn associated with improved IYCF practices: early initiation of breastfeeding, exclusive breastfeeding, minimum meal frequency and dietary diversity. Bargaining power consisted of four domains: (i) ownership and control of assets; (ii) social participation; (iii) workload; and (iv) household decision-making control and were primarily measured using additive scales. We used generalized structural equation modelling to examine if exposure to IYCF information mediated the relationship between the bargaining domains and the four IYCF practices, separately. Social participation was positively associated with exposure to IYCF information (β = 0.266, P < .001), which in turn was related to early initiation (β = 0.241, P = .001). We obtained similar results for the relationship between social participation and dietary diversity. Decision-making control was directly associated with exclusive breastfeeding (β = 0.350, P = .036). No domains were associated with minimum meal frequency. Different domains of women's bargaining power may relate to exposure to nutrition information and IYCF behaviours. Understanding specific domains of bargaining power is critical to developing interventions that can effectively address gender-related issues that underlie child nutrition outcomes.

Life After College: Employment, Social, and Community Outcomes for Young Deaf Adults

While most research on transition outcomes focuses on education and employment, the transition to adulthood also includes social outcomes, such as group involvement and community service. The present study examined a broader set of outcomes for young deaf adults after postsecondary education. A secondary analysis of a large-scale data set, the National Longitudinal Transition Study (NLTS2), was conducted to compare the employment, income assistance, and social/community outcomes of three postsecondary education cohorts: graduates, noncompleters, and nonattendees. The findings indicate that young deaf adults with more postsecondary education have more positive outcomes, e.g., higher employment rates, higher wages, and greater civic and social participation. These findings further demonstrate the importance of postsecondary education for young deaf adults and can be used to inform transition planning for deaf students, supporting the need to consider exploration of various career pathways available through college or postsecondary career/technical education.

Best Practices for Encouraging Student Participation in Both Face-to-Face and Virtual Environments

Sense of community is valued in higher education but can become a challenge, especially when classroom time is reduced or eliminated in blended and online coursework. As COVID-19 has forced the rapid transition to remote teaching, strategies for optimizing interactivity and discussion in both synchronous and asynchronous environments have become increasingly important. Here we focus first on the theoretical framework for the importance of sense of community in education, followed by a discussion of evidence-based variables that increase students' sense of belonging. Emphasis is placed on strategies that promote discussion and participation across course formats.

Pathways to mental health improvement in a community-led area-based empowerment initiative: evidence from the Big Local 'Communities in Control' study, England

BACKGROUND

Area-based initiatives that include a focus on community empowerment are increasingly being seen as potentially an important way of improving health and reducing inequalities. However, there is little empirical evidence on the pathways between communities having more control and health outcomes.

PURPOSE

To identify pathways to health improvement in a community-led area-based community empowerment initiative.

METHODS

Longitudinal data on mental health, community control, area belonging, satisfaction, social cohesion and safety were collected over two time points, 6 months apart from 48 participants engaged in the Big Local programme, England. Qualitative comparative analysis (QCA) was used to explore pathways to health improvement.

RESULTS

There was no clear single pathway that led to mental health improvement but positive changes in 'neighbourhood belonging' featured in 4/5 health improvement configurations. Further, where respondents experienced no improvement in key social participation/control factors, they experienced no health improvement.

CONCLUSION

This study demonstrates a potential pathway between an improvement in 'neighbourhood belonging' and improved mental health outcomes in a community empowerment initiative. Increasing neighbourhood belonging could be a key target for mental health improvement interventions.

Social influences on smoking cessation in mid-life: Prospective cohort of UK women

INTRODUCTION

Decisions to quit smoking are thought to be influenced by social factors such as friends, family and social groups, but there have been few attempts to examine comprehensively the influence of a range of social factors on smoking cessation. In the largest study to date, we examined whether smoking cessation was associated with marital status and the smoking habits of a partner, socio-economic status and social participation.

METHODS

In the prospective Million Women Study, 53,650 current smokers in 2001 (mean age 58.3, SD 4.4) reported their smoking status 4 years later; and reported on social factors on both occasions. Logistic regression yielded odds ratios (ORs) and 99% confidence intervals (CIs) for stopping smoking in the next 4 years by marital status, whether their partner smoked, deprivation, education, and participation in social activities.

RESULTS

31% (16,692) of the current smokers at baseline had stopped after 4 years. Smokers who were partnered at baseline were more likely to quit than those who were not partnered (OR 1.13, 99% CI 1.06-1.19). Compared to having a partner who smoked throughout, those who had a non-smoking partner throughout were more likely to quit (OR 2.01, 99% CI 1.86-2.17), and those who had a partner who smoked at baseline but stopped smoking in the next 4 years were even more likely to quit (OR 6.00, 5.41-6.67). There was no association with cessation for education or deprivation. The association with social participation varied by type of activity but was null overall.

CONCLUSION

Women who were partnered were most likely to stop smoking if their partner also stopped smoking. There was little evidence of a strong influence of either socio-economic status or social participation on smoking cessation. These results emphasise the importance of a spouse's smoking habits on the likelihood of a smoker successfully quitting smoking.

Quality of life: A universal or a disability specific concept?

BACKGROUND.

Quality of life (QoL) is an important outcome of occupational therapy practice. Autism spectrum disorder (ASD) is a neurodevelopmental disorder that impacts the individual throughout their lifespan and may substantially affect QoL. Measuring QoL of people with ASD presents a challenge and a debate whether to use general versus disability-specific adapted measures.

PURPOSE.

This paper aims to (a) revisit the construct of QoL and discuss specific dilemmas pertaining to its measurement, and (b) discuss implications to the assessment of QoL in individuals with ASD while highlighting the potential contribution of occupational therapy to the development of measures.

KEY ISSUES.

We suggest adding the domain of accessibility into QoL assessments, including, physical, sensory, social, and cognitive aspects, and to use disability-specific QoL measures.

IMPLICATIONS.

The paper presents a call for occupational therapists to be involved in developing specific ASD disability-oriented measures that consider the unique characteristics of the disorder and environmental supports.

Perspectives on Active Transportation in a Mid-Sized Age-Friendly City: "You Stay Home"

Background: Active transportation is an affordable and accessible form of transportation that facilitates the mobility of older adults in their communities. Age-friendly cities encourage and support physical activity and social participation among older adults; however, they often do not adequately address active transportation. Our goal was to identify and understand the constraints to active transportation that older adults experience in order to inform the development of viable solutions. Methods: Focus group interviews were conducted with community dwelling older adults (n = 52) living in the City of Oshawa in Ontario, Canada; each focus group targeted a specific demographic to ensure a diverse range of perspectives were represented. Data were analyzed to identify themes; sub-group analyses were conducted to understand the experience of those from low socioeconomic status and culturally diverse groups. Results: Themes pertaining to environmental, individual, and task constraints, as well as their interactions, were identified. Of particular novelty, seemingly non-modifiable constraints (e.g., weather and personal health) interacted with modifiable constraints (e.g., urban design). Culturally diverse and lower socioeconomic groups had more favorable perspectives of their neighborhoods. Conclusion: While constraints to active transportation interact to exacerbate one another, there is an opportunity to minimize or remove constraints by implementing age-friendly policies and practices.

Prenatal yoga for young women a mixed methods study of acceptability and benefits

BACKGROUND

High rates of psychological-distress, trauma and social complexity are reported among young pregnant women. At the Royal Women's Hospital, Australia, young pregnant women acknowledge wanting tools to improve maternal wellbeing yet remain challenging to engage in antenatal education and support. While yoga is a widely accepted and participated activity in pregnancy, with demonstrated benefits for adult pregnant women, adolescent women are often excluded from both these yoga interventions and related pregnancy studies.

METHODS

This mixed methods study examined the acceptability and benefits of yoga for young women. We recruited 30 participants aged under 24 years, who were offered twice a week, one-hour voluntary prenatal yoga sessions throughout their pregnancy. A medical file audit gathered baseline demographics, pre and post yoga session surveys were administered and brief individual interview were conducted with study participants.

RESULTS

While 26 study participants were positive about the availability of a yoga program, only 15 could attend yoga sessions (mean = 8 sessions, range 1-27). No differences were found in the demographic or psychosocial factors between those who did and did not attend the yoga sessions. The medical file audit found that 60% of all the study participants had a documented history of psychological distress. Barriers to participation were pragmatic, not attitudinal, based on the timing of the group sessions, transport availability and their own health. All study participants identified perceived benefits, and the yoga participants identified these as improved relaxation and reduction of psychological distress; labour preparation; bonding with their baby in utero; and social connectedness with the yoga group peers.

CONCLUSIONS

This study demonstrated yoga was acceptable to young pregnant women. For those who did participate in the sessions, yoga was found to decrease self-reported distress and increase perceived skills to assist with their labour and the birth of their baby. The provision of accessible yoga programs for pregnant young women is recommended.

At the grassroots of home and community-based aged care: strategies for successful consumer engagement

OBJECTIVES

(1) To describe the processes used to plan and conduct a stakeholder forum in aged care as a means of informing future uptake of consumer participatory research. (2) To discuss how capturing and drawing on stakeholders' experiences of aged care can generate new research ideas and inform the delivery of more person-centred aged care services.

KEY PRINCIPLES OF CONSUMER ENGAGEMENT

A stakeholder forum was conducted as part of Ageing Well, a 2-year project evaluating the value and impact of social participation and quality of life tools as part of routine community aged care assessments at a large Australian provider. The forum was codesigned with community aged care clients and care coordinators and aimed to coproduce implementation strategies with a targeted representation of stakeholders. The stakeholder forum was developed using five key principles of consumer engagement activities: purposeful, inclusive, timely, transparent and respectful. The forum fostered an environment of mutual respect and collective inquiry to encourage contributions from all participants. This article outlines practical guidance on using a consumer engagement framework and the lessons learnt.

DISCUSSION

The stakeholder forum facilitated an understanding of consumers' needs and existing gaps in aged care services and the circumstances that can enable or hinder the delivery and implementation of these services. This collective information can guide future research and policy at institutional, regional and national committees that relate to aged care.

TRIAL REGISTRATION NUMBER

ACTRN12617001212347.

Empirical Evidence for Professional Practice and Public Policies: An Exploratory Study on Social Exclusion in Users of Primary Care Social Services in Spain

This study examines the social exclusion characteristics of a sample of users of primary care social services in two local entities in Spain. The objective of this study was to identify the intensity and scope of social exclusion in an exploratory way and to look at the typology of existing exclusionary situations to inform policy making and professional practice. Data from 1009 users were collected by primary care social services professionals, completing the Social Exclusion Scale of the University of Alicante (SES-UA). The dimensions with the greatest levels of social exclusion in the study population were those related to work/employment, income and education and training. The dimensions with an intermediate level of exclusion were those related to housing and social isolation. Social acceptance, family and social conflict and health were the dimensions with the lowest levels of exclusion. The analysis also showed the existence of five significantly different groups, that showed five different life trajectories along the continuum between social exclusion and social inclusion. The results show the importance and utility of developing professional and policy intervention protocols based on research evidence, with the objective of improving the quality of life of the users.

The social cure of social prescribing: a mixed-methods study on the benefits of social connectedness on quality and effectiveness of care provision

OBJECTIVES

This study aimed to assess the degree to which the 'social cure' model of psychosocial health captures the understandings and experiences of healthcare staff and patients in a social prescribing (SP) pathway and the degree to which these psychosocial processes predict the effect of the pathway on healthcare usage.

DESIGN

Mixed-methods: Study 1: semistructured interviews; study 2: longitudinal survey.

SETTING

An English SP pathway delivered between 2017 and 2019.

PARTICIPANTS

Study 1: general practitioners (GPs) (n=7), healthcare providers (n=9) and service users (n=19). Study 2: 630 patients engaging with SP pathway at a 4-month follow-up after initial referral assessment.

INTERVENTION

Chronically ill patients experiencing loneliness referred onto SP pathway and meeting with a health coach and/or link worker, with possible further referral to existing or newly created relevant third-sector groups.

MAIN OUTCOME MEASURE

Study 1: health providers and users' qualitative perspectives on the experience of the pathway and social determinants of health. Study 2: patients' primary care usage.

RESULTS

Healthcare providers recognised the importance of social factors in determining patient well-being, and reason for presentation at primary care. They viewed SP as a potentially effective solution to such problems. Patients valued the different social relationships they created through the SP pathway, including those with link workers, groups and community. Group memberships quantitatively predicted primary care usage, and this was mediated by increases in community belonging and reduced loneliness.

CONCLUSIONS

Methodological triangulation offers robust conclusions that 'social cure' processes explain the efficacy of SP, which can reduce primary care usage through increasing social connectedness (group membership and community belonging) and reducing loneliness. Recommendations for integrating social cure processes into SP initiatives are discussed.

Creative social media use and political participation in young people: The moderation and mediation role of online political expression

INTRODUCTION

Educators and policymakers promote political participation in young people as a means to strengthen the legitimacy of democracy. Creative social media use has grown in popularity in the digital age; however, this creative usage still receives inadequate attention in the literature-particularly its association with political participation.

METHOD

This study collected three-wave panel data from a sample of young people living in Hong Kong (56.9% male, mean age = 18.81, standard deviation = 2.70) and used cross-lagged structural equation modeling to evaluate the mediating and moderating roles of online political expression in the link between creative social media and political participation.

RESULTS AND CONCLUSIONS

The results showed that creative social media use positively predicted political participation indirectly by the full mediation of enhanced online political expression. Findings did not reveal the moderation role of online political expression in the link between creative use of social media and political participation. Findings make important theoretical contributions in the field linking social media usage to political engagement.

Social participation and the combination of future needs for long-term care and mortality among older Japanese people: a prospective cohort study from the Aichi Gerontological Evaluation Study (AGES)

OBJECTIVES

Our study aimed to examine the longitudinal association between social participation and both mortality and the need for long-term care (LTC) simultaneously.

DESIGN

A prospective cohort study with 9.4 years of follow-up.

SETTING

Six Japanese municipalities.

PARTICIPANTS

The participants were 15 313 people who did not qualify to receive LTC insurance at a baseline based on the data from the Aichi Gerontological Evaluation Study (AGES, 2003-2013). They received a questionnaire to measure social participation and other potential confounders. Social participation was defined as participating in at least one organisation from eight categories.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcomes were classified into three categories at the end of the 9.4 years observational period: living without the need for LTC, living with the need for LTC and death. We estimated the adjusted OR (AOR) using multinomial logistic regression analyses with adjustment for possible confounders.

RESULTS

The primary analysis included 9741 participants. Multinomial logistic regression analysis revealed that social participation was associated with a significantly lower risk of the need for LTC (AOR 0.82, 95% CI 0.69 to 0.97) or death (AOR 0.78, 95% CI 0.70 to 0.88).

CONCLUSIONS

Social participation may be associated with a decreased risk of the need for LTC and mortality among elderly patients.

A research tool for measuring non-participation of older people in research on digital health

BACKGROUND

Healthcare services are being increasingly digitalised in European countries. However, in studies evaluating digital health technology, some people are less likely to participate than others, e.g. those who are older, those with a lower level of education and those with poorer digital skills. Such non-participation in research - deriving from the processes of non-recruitment of targeted individuals and self-selection - can be a driver of old-age exclusion from new digital health technologies. We aim to introduce, discuss and test an instrument to measure non-participation in digital health studies, in particular, the process of self-selection.

METHODS

Based on a review of the relevant literature, we designed an instrument - the NPART survey questionnaire - for the analysis of self-selection, covering five thematic areas: socioeconomic factors, self-rated health and subjective overall quality of life, social participation, time resources, and digital skills and use of technology. The instrument was piloted on 70 older study persons in Sweden, approached during the recruitment process for a trial study.

RESULTS

Results indicated that participants, as compared to decliners, were on average slightly younger and more educated, and reported better memory, higher social participation, and higher familiarity with and greater use of digital technologies. Overall, the survey questionnaire was able to discriminate between participants and decliners on the key aspects investigated, along the lines of the relevant literature.

CONCLUSIONS

The NPART survey questionnaire can be applied to characterise non-participation in digital health research, in particular, the process of self-selection. It helps to identify underrepresented groups and their needs. Data generated from such an investigation, combined with hospital registry data on non-recruitment, allows for the implementation of improved sampling strategies, e.g. focused recruitment of underrepresented groups, and for the post hoc adjustment of results generated from biased samples, e.g. weighting procedures.

Change in social support while participating in behavioral activation for PTSD

OBJECTIVE

Lack of social support predicts the development, maintenance, and exacerbation of posttraumatic stress disorder (PTSD). Moreover, social dysfunction is associated with recurrent episodes of PTSD care, and detachment/estrangement from others is a strong predictor of suicidal ideation among those with PTSD. Thus, treatments to improve social functioning among those with PTSD are needed.

METHOD

Eighty veterans of recent operations in Iraq and Afghanistan participated in a randomized controlled trial comparing treatment as usual to behavioral activation (BA) for PTSD, a treatment that focuses on reducing avoidance behaviors and increasing engagement in valued goals rather than explicitly confronting trauma memories.

RESULTS

Mixed-model regression analyses revealed that, accounting for gender, baseline PTSD, and marital status, participants who received BA experienced greater improvements in the number of social supports from baseline to posttreatment compared with those in treatment as usual (F1,96 = 6.29, p = .014). Gains were not maintained at 3-month follow-up, and significant results were not found for satisfaction with social supports.

CONCLUSIONS

BA may facilitate an increase in the perceived number of social supports available to veterans with PTSD, but treatment adaptation may be necessary to maintain these gains and to increase satisfaction with social support. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Unified Extracurricular Activities as a Pathway to Social Inclusion in High Schools

The present study examined how a multicomponent intervention embedded in a high school's extracurricular framework impacts students' acceptance of peers with intellectual disability (ID). Data were collected from eight high schools, three of which implemented the Special Olympics Unified Champion Schools (UCS) program involving inclusive sports, clubs, and schoolwide events, and five of which did not. A pretest-posttest survey design was used to measure students' attitudes, perceptions, and interactions (n = 1,230). Lagged dependent variable modeling revealed that UCS participation significantly predicted improved attitudes toward peers with ID and perceptions of school social inclusion, as well as increased social interactions with peers with ID. Unified extracurricular activities may be the next step forward in promoting an inclusive school culture.