Exploring the Role of Social Support in Promoting Community Integration: An Integrated Literature Review

Informal Helping and Subsequent Health and Well-Being in Older U.S. Adults

BACKGROUND

Growing evidence suggests that informal helping (unpaid volunteering not coordinated by an organization or institution) is associated with improved health and well-being outcomes. However, studies have not investigated whether changes in informal helping are associated with subsequent health and well-being.

METHODS

This study evaluated if changes in informal helping (between t0;2006/2008 and t1;2010/2012) were associated with 35 indicators of physical, behavioral, and psychosocial health and well-being (at t2;2014/2016) using data from 12,998 participants in the Health and Retirement study - a national cohort of US adults aged > 50.

RESULTS

Over the four-year follow-up period, informal helping ≥ 100 (versus 0) hours/year was associated with a 32% lower mortality risk (95% CI [0.54, 0.86]), and improved physical health (e.g., 20% reduced risk of stroke (95% CI [0.65, 0.98])), health behaviors (e.g., 11% increased likelihood of frequent physical activity (95% CI [1.04, 1.20])), and psychosocial outcomes (e.g., higher purpose in life (β = 0.15, 95% CI [0.07, 0.22])). However, there was little evidence of associations with various other outcomes. In secondary analyses, this study adjusted for formal volunteering and a variety of social factors (e.g., social network factors, receiving social support, and social participation) and results were largely unchanged.

CONCLUSIONS

Encouraging informal helping may improve various aspects of individuals' health and well-being and also promote societal well-being.

Distal supports, capabilities, and growth-focused recovery: A comparison of Housing First and the staircase continuum of care

Adults who have substantial histories of homelessness and complex support needs may feel ambivalent about integrating into their communities and find it difficult to do so. Being familiar to and recognized by others as a resident in a neighborhood or community are sources of "distal support" that provide individuals with feelings of belonging to their community and are important to recovery from homelessness. We hypothesized that individuals engaged with Housing First (HF) programs would report more distal support than individuals engaged with traditional homeless services (treatment as usual, TAU), and that distal support would predict more community integration, growth-related recovery, and achieved capabilities. We analyzed data collected from homeless services users (n = 445) engaged with either HF or TAU in eight European countries. Measures included achieved capabilities, growth-focused recovery, distal supports, and community integration. Serial mediation analyses confirmed our hypothesis that the effects of HF on growth-related recovery and achieved capabilities are indirect, mediated by distal supports and community integration. Findings are discussed in relation to the importance of modeling the effects of HF on social and psychological outcomes as indirect and identifying important mediators that translate the effects of HF components on social and psychological outcomes. We also note the importance of case management activities that encourage clients to develop and sustain distal supports with others who live and work in their neighborhoods.

Community integration and its predictors in people with stroke: a multicenter longitudinal study

OBJECTIVE

To investigate the community integration of patients following stroke and determine the predictors of their level of community integration at 1-year follow-up.

DESIGN

A multicenter, longitudinal, and observational study.

SUBJECTS

Sixty-five inpatients (41 men) with a mean age of 56.9 (standard deviation = 17.0) years, who had their first stroke at least 1 month prior to this study were recruited from 4 rehabilitation inpatient wards in China.

METHODS

In the initial assessment, the participants were evaluated using the Community Integration Questionnaire, the Fugl-Meyer Assessment, the Berg Balance Scale, the Modified Barthel Index, the Mini Mental State Examination, and the Modified Ashworth Scale. In the follow-up assessments, which were conducted via telephone no less than 1 year after discharge, the participants were evaluated using the Community Integration Questionnaire and also assessed for other disease-related conditions.

RESULTS

The participants' scores on the Community Integration Questionnaire in the follow-up assessment were significantly greater than those at the initial assessment (p < 0.05). In addition, the participants' Community Integration Questionnaire scores in the follow-up assessment were significantly correlated with their ages, numbers of years of education, and Modified Barthel Index, Berg Balance Scale, Mini Mental State Examination scores in the initial assessment (p < 0.05), and marginally significantly correlated with their scores on Fugl-Meyer Assessment in the initial assessment (p = 0.058). The participants' ages, numbers of years of education, and Modified Barthel Index, Berg Balance Scale, Mini Mental State Examination, Fugl-Meyer Assessment of the lower extremity, and Fugl-Meyer Assessment scores in the initial assessment were predictive of their Community Integration Questionnaire scores at follow-up, with coefficients of determination ranging from 0.254 to 0.056 (p < 0.05).

CONCLUSIONS

The level of community integration of the participants was generally low, but it was greater at 1-year follow-up than it was initially. Balance function and daily living ability may be key predictors of community integration of patients following stroke.

Structural Equation Model for Social Support and Quality of Life Among Individuals With Mental Health Disorders During the COVID-19 Pandemic

BACKGROUND

In light of the COVID-19 pandemic, the distribution of social support for mental health problems has likely become unequal. Family- and community-based social support has been recognized as a promising approach for mental disorders; however, limited global frameworks have been applied to developing countries such as Vietnam.

OBJECTIVE

The aim of this study was to evaluate the quality of life and social support among patients with mental health disorders in Vietnam and to investigate the factors associated with quality of life among these patients.

METHODS

A cross-sectional study was conducted on 222 psychiatric patients in Hanoi from 2020 to 2022. A structured questionnaire was developed based on four standardized scales: Mental Well-Being-5 scale, Multidimensional Scale of Perceived Social Support, EuroQoL-visual analog scale (EQ-VAS), and EuroQoL-5 dimensions-5 levels (EQ-5D-5L) scale. Tobit regression was used to identify factors associated with the EQ-5D-5L and EQ-VAS scores. Structural equation modeling was applied to verify the relationship between quality of life and social support.

RESULTS

The results showed that perceived support from family scored the highest compared to support from friends and significant others. Patients with depression reported the lowest quality of life and perceived social support. Structural equation modeling showed a root mean square error of approximation of 0.055 (90% CI 0.006-0.090), comparative fit index of 0.954, Tucker-Lewis index of 0.892, and standardized root mean squared error of 0.036 (P<.001). The hypothetical model indicated statistically significant correlations between EQ-VAS score and social support (P=.004), EQ-5D-5L and mental well-being (P<.001), and social support and mental well-being (P<.001). Critical deterioration of quality of life and inconsistency in social support for patients with mental illness were also recorded.

CONCLUSIONS

There is a need to enhance social support and service delivery in Vietnam, focusing on occupation and quality of life. The correlations between social support, quality of life, and mental health issues suggest the potential of a clinical-social integrated intervention model of care.

Veterans Finding Community and a "Home" Within an Emergency Housing Environment

In April 2020, the Department of Veterans Affairs responded to the COVID-19 pandemic and escalating unsheltered homelessness in Los Angeles by sanctioning a tent turned tiny shelter encampment at the West Los Angeles Veterans Affairs medical center. Initially, staff offered linkages to on-campus VA healthcare. However, as many Veterans living in the encampment struggled to avail themselves of these services, our "encampment medicine" team was launched to provide on-site care coordination and healthcare at the tiny shelters. This case study showcases the team's engagement with a Veteran experiencing homelessness struggling with opioid use disorder and depicts how this co-located, comprehensive care team allowed for trusting care relationships formed with, and empowerment of the Veterans living in the encampment. The piece highlights a healthcare model that engages with persons experiencing homelessness on their own terms while building trust and solidarity, focuses on the sense of community that formed in the tiny shelter encampment, and gives recommendations for how homeless services might adapt to use the strengths of this unique community.

Factors associated with personal recovery among psychiatric nursing home residents

WHAT IS KNOWN ABOUT THE SUBJECT?: Poor recovery will cause harm to the quality of life and well-being of residents and that the scope of influence includes the self, family and society. No study to date has investigated empowerment and the other multiple factors associated with personal recovery among psychiatric nursing home residents. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: The factors associated with personal recovery are empowerment, social support and global functioning. This pioneer study contributes new evidence that personal recovery is mainly predicted by empowerment, social support and global function, with empowerment exhibiting the highest predictive value. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Strengthening empowerment in mental health nursing may contribute more to the personal recovery of psychiatric nursing home residents than improving global function or social support. Mental health professionals should shift to empowerment-oriented care to improve individuals' personal recovery, such as offering more opportunities to achieve autonomy, encouraging individuals' involvement in decision-making and promoting individuals' motivation for achieving their goals. ABSTRACT: Introduction Individuals diagnosed with mental illness have a need for recovery. No study to date has investigated empowerment and the other multiple factors associated with personal recovery among psychiatric nursing home residents. Aim The study aimed to identify the factors associated with personal recovery among psychiatric nursing home residents. Methods This was a cross-sectional study with convenience sampling. Participants were recruited from a psychiatric nursing home in Northern Taiwan between April and June 2018. Data were collected through self-reported, structured questionnaires with verified reliability and validity. Descriptive and hierarchical regression analyses were performed. The present study followed the STROBE guidelines. Results The study included 158 participants. The factors associated with recovery according to bivariate associations were religious belief, psychotic symptoms, global function, social support and empowerment. In the hierarchical regression, empowerment, social support and global function were the main predictive factors of recovery, with the explained variation reaching 40.8%. Empowerment exhibited the highest predictive value for the recovery. Implications for clinical practice Strengthening empowerment in mental health nursing may contribute more to the personal recovery of psychiatric nursing home residents than improving global function or social support.

How to motivate planners to participate in community micro-renewal: An evolutionary game analysis

In China, grassroots governments have attempted to introduce community planners into community micro-renewal, using their expertise to guide the design and implementation of community micro-renewal. However, issues remain to be studied and resolved, including how to effectively play the community planner role to coordinate multiple parties’ interests. This study constructed an evolutionary game model based on the behaviors of multiple subjects with participation by community planners, to establish the payment functions on both sides of the game under different choice strategies; explore evolutionary stabilization strategies by replication dynamic equations; and to analyze the conditions for the multi-party evolutionary game to reach the ideal stable state. The findings: (1) Show that financial subsidies provided by the grassroots government to community planners have a positive effect on the latter’s behavioral choices; (2) Illustrate the path of the tripartite evolutionary game among the grassroots government, residents, and community planners to reach ideal stability (incentive, active participation, and positive promotion); and (3) Describe how the project benefits from community planners promoting community micro-renewal can effectively promote their positive behavioral choices.

Volunteering as a Meaningful Occupation in the Process of Recovery From Serious Mental Illness: A Qualitative Study

IMPORTANCE

Volunteering is an activity that facilitates social welfare, a sense of connection to others, and the construction of links with other people and the community.

OBJECTIVE

To describe the experience of a group of people with serious mental illness (SMI) who engaged in community volunteer work.

DESIGN

Qualitative, phenomenological study using purposeful sampling and an inductive thematic analysis.

SETTING

Several mental health community centers in Madrid and Catalonia, Spain.

PARTICIPANTS

People with SMI engaged in community volunteer work. Outcomes and Measures: In-depth interviews were used to collect data.

RESULTS

Two themes, with four subthemes each, emerged from the data: (1) engaging in a meaningful occupation enhances the recovery process (subthemes: undergoing positive experiences, performing or resuming a meaningful occupation, living in the present moment, and relating with one's social and family environment) and (2) a process of mutual support (subthemes: in helping others, you help yourself; helping others on the basis of one's first-person experience; recover before you can help others; and role of professionals in volunteering).

CONCLUSIONS AND RELEVANCE

Volunteering is perceived as a meaningful occupation. Helping others generates a reciprocal benefit that favors the recovery process and contributes to the establishment of personal and social bonds. What This Article Adds: This study provides a basis for understanding the potential of volunteering to be a meaningful occupation in the recovery process of people with SMI. It can help occupational therapy practitioners develop volunteer-based intervention programs that support the recovery process.

Towards a contemporary social care 'prevention narrative' of principled complexity: An integrative literature review

Prevention has become increasingly central in social care policy and commissioning strategies within the United Kingdom (UK). Commonly there is reliance on understandings borrowed from the sphere of public health, leaning on a prevention discourse characterised by the 'upstream and downstream' metaphor. Whilst framing both structural factors and responses to individual circumstances, the public health approach nonetheless suggests linearity in a cause and effect relationship. Social care and illness follow many trajectories and this conceptualisation of prevention may limit its effectiveness and scope in social care. Undertaken as part of a commissioned evaluation of the Social Services and Wellbeing Act (2014) Wales, a systematic integrative review was conducted to establish the key current debates within prevention work, and how prevention is conceptually framed, implemented and evaluated within the social care context. The databases Scopus, ASSIA, CINAHL and Social Care Online were initially searched in September 2019 resulting in 52 documents being incorporated for analysis. A further re-run of searches was run in March 2021, identifying a further 14 documents, thereby creating a total of 66. Predominantly, these were journal articles or research reports (n = 53), with the remainder guidance or strategy documents, briefings or process evaluations (n = 13). These were categorised by their primary theme and focus, as well as document format and research method before undergoing thematic analysis. This highlighted the continued prominence of three-tiered, linear public health narratives in the framing of prevention for social care, with prevention work often categorised and enacted with inconsistency. Common drivers for prevention activity continue to be cost reduction and reduced dependence on the care system in the future. Through exploring prevention for older people and caregivers, we argue for an approach to prevention aligning with the complexities of the social world surrounding it. Building on developments in complexity theory in social science and healthcare, we offer an alternative view of social care prevention guided by principles rooted in the everyday realities of communities, service users and caregivers.

The adaptation of the community integration scale for adults with psychiatric disorders into Chinese: Cross-cultural adaptation, reliability and validity

Community integration problems are fundamental to psychosis and are part of the diagnostic criteria for schizophrenia, but there is a lack of relevant researches and validated scales available for use in China. We intend to translate and assess the reliability and validity of the Community Integration Scale for Adults with Psychiatric Disorders (CIS-APP) scale. A cross-sectional study was conducted on a sample of 612 schizophrenic patients in China. The CIS-APP was used to collect data, and the raw data were randomly divided into two parts for an exploratory factor analysis and a confirmatory factor analysis, to evaluate construct validity. Content validity and reliability were tested by content validity index and Cronbach's α coefficients、split-half reliability respectively. A six-factor structure was emerged, and it explained 61.762% of the total variance. The fit of the six-factor model was acceptable, and the standardized factor loadings ranged from 0.412 to 0.903. The computed reliability of the scale was 0.915. The CIS-APP has excellent psychometric properties, and can be applied to measure community integration levels in people with schizophrenia.

Beyond behaviour: rethinking integration for people experiencing homelessness

Integration is one of the main goals of homeless services. Despite the growing research on integration and homelessness, few studies start with the perspective of people experiencing homelessness. Integration is often measured as participation in a list of standard behaviours. This process assesses behaviour in accordance with social norms but ignores people's own feelings and understanding of integration. The main aim of this study is to explore the meaning of integration from the perspective of people experiencing homelessness. Data were collected through semi-structured interviews involving 26 people in homeless service programmes. Five main themes regarding the meanings of integration were generated: work, housing, respectful relationships, family and personal dignity. Moreover, two themes of obstacles and facilitators affecting integration were identified. A new conceptualisation of integration is generated that captures the participants' sense of personal dignity, respect and recognition from others and a sense of utility within their living environments (work, house and family). Implications of the results are discussed with respect to homeless services and research on homelessness.

Immigration, perceived discrimination and mental health: evidence from Venezuelan population living in Peru

Background

The association between international migration and mental health is conditioned to several factors, and discrimination may play a significant role. Currently, Peru is one of the principal Venezuelan migrant-receiving countries in Latin America. There are around one million Venezuelan refugees and migrants in the country. This study evaluates the association between self-perceived discrimination and mental health problems in Venezuelan population living in Peru.

Method

We analyzed data from the Venezuelan Population Residing in Peru Survey 2018, a nationally representative urban sample aimed at collecting information on several dimensions of Venezuelan population wellbeing. We applied logistic regression models to assess the association between self-perceived discrimination and mental health problems. Moreover, we applied the propensity score matching method as a robustness check of our results.

Results

Of 9487 Venezuelans surveyed, 6806 included complete information. From this sample, 6.3% reported mental health problems related to fear, anger, anxiety, or stress. Logistic regression models showed that Venezuelans who perceived being discriminated against had 2.4 higher odds of presenting mental health problems than their non-discriminated counterparts. Moreover, propensity score matching models showed that Venezuelans who perceived being discriminated against increased by 3.5 percentage points their probability of presenting mental health problems compared to their non-discriminated counterparts.

Conclusions

There is evidence that self-perceived discrimination is associated with mental health deterioration in Venezuelan migrants living in Peru. Our findings are relevant in the current geopolitical context and could be useful in the decision making processes in international health.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12992-020-00655-3.

Community mental healthcare: new developments and innovative strategies

PURPOSE OF REVIEW

The aim of this scoping review was to identify and map the available evidence on recent innovations in community mental healthcare across the globe.

RECENT FINDINGS

This review highlights the different innovative approaches and strategies being currently used in the field of community mental health. Key approaches found in the reviewed studies include collaborative care with the inclusion of peer workers, growing use of e-health and telepsychiatry, improved reforms on national mental health policies and de-institutionalization, modification of outreach models and mental health promotion in the community. The studies reviewed here suggest that continued innovation and implementation of new models and strategies have the potential to reduce the burden of disease and increase the quality of life for patients with mental health issues.

SUMMARY

Growing body of evidence shows that integrative care is the new standard of care for people with mental illnesses, with necessity of continuity of care from emergency department to community mental health services. Social determinants of rehabilitation and recovery, and peers support remain a new main topic of research in area of treatment of people with severe mental illnesses. E-health tools are becoming prevalent in the processes of promotion, prevention and treatment in mental healthcare.

Exploring the Association of Community Integration in Mental Health among Formerly Homeless Individuals Living in Permanent Supportive Housing

Supportive housing has been widely used among persons experiencing chronic homelessness and/or mental health conditions. While it has been demonstrated to be effective in addressing homelessness among populations with complex needs, community integration remains a challenge. Community integration is the extent to which individuals live, participate, and socialize in their community and consists of three aspects: physical, social, and psychological. The study utilized data from the Transitions to Housing project that followed formerly homeless individuals (N = 383) throughout their first year of residence in permanent supportive housing (PSH). The study set out to examine which aspects of community integration are associated with mental health symptoms in this population. Five nested multivariate linear regression models were conducted and then compared. The model that accounted for demographics, substance use, neighborhood quality, and all three aspects of community integration simultaneously was the best fit and explained the most variance in mental health symptoms (24%). The complete model suggested higher levels of psychological integration were significantly associated with decreased mental health symptoms in this sample. This finding suggests fostering a sense of belonging among PSH residents could improve mental health outcomes. Implications for practice and future research are discussed.