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Dulek EB, Stein CH. The Way I See It: Older Adults with Mental Illness Share Their Views of Community Life Using Photovoice. Community Ment Health J 2024; 60:457-469. [PMID: 37874437 DOI: 10.1007/s10597-023-01192-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/15/2023] [Indexed: 10/25/2023]
Abstract
The importance of community involvement for both older adults and individuals coping with mental illness is well documented. Yet, barriers to community integration for adults with mental illness such as social stigma, discrimination, and economic marginalization are often exacerbated by increased health and mobility challenges among older adults. Using photovoice, nine older adults with mental illness represented their views of community in photographs and group discussions over a six-week period. Participant themes of community life included physical spaces, valued social roles, and access to resources in the community. Themes were anchored by older adults' perceptions of historical and cultural time comparisons between 'how things used to be' and 'how things are now.' Barriers to community integration were often related to factors such as age, mobility, and resources rather than to mental health status. Program evaluation results suggest photovoice can promote self-reflection, learning, and collaboration among older adults with mental illness.
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Affiliation(s)
- Erin B Dulek
- Milwaukee VA Medical Center, 5000 W. National Ave, Milwaukee, WI, 53295, USA.
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Uemura JI, Uno K, Hoshino A, Sano T, Tanikaga M, Tanaka M, Mizuno J. Pandemic-Induced Occupational Disruption and Association With Health in Japanese Community-Dwelling Older Adults. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2023:15394492231215515. [PMID: 38059483 DOI: 10.1177/15394492231215515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
The COVID-19 pandemic caused occupational disruption and adverse health outcomes in community-dwelling older adults. This study aimed to investigate the extent of occupational disruption in older adults and its relationship to health-related quality of life (QOL), depression, and frailty. In this cross-sectional study, retention rates in four activity domains and relationships with health outcomes were examined in Japanese older adults aged ≥65 years (n=163) using canonical correlation analysis (CCA) and mixed linear models. More than 25% of activities were restricted compared with the pre-pandemic period. CCA demonstrated correlations between four retention rates and health outcomes (canonical correlation = .42, p = .0003). Retention in instrumental and social activities independently predicted QOL and depression (p < .05). This study highlights that different activities may have different effects on health outcomes and can provide community occupational therapy practitioners with a perspective to assess occupational disruption and identify activities for intervention.
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Affiliation(s)
- Jun-Ichi Uemura
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Japan
| | - Kohei Uno
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Japan
| | - Aiko Hoshino
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Japan
| | - Tatsuhiko Sano
- Department of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Japan
| | - Miki Tanikaga
- Department of Occupational Therapy, College of Life Health Sciences, Chubu University, Nagoya, Japan
| | - Masahiro Tanaka
- Department of Rehabilitation, Nihon Fukushi University, Handa, Japan
| | - Junpei Mizuno
- Graduate school of human and environmental studies, Kyoto University, Japan
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Walker B, Munford L. The social capital penalty paid by teetotallers. SSM Popul Health 2023; 23:101437. [PMID: 37273823 PMCID: PMC10239063 DOI: 10.1016/j.ssmph.2023.101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/26/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
Social capital is important and helps protect health and reduce loneliness. Governments worldwide are pursuing policies to reduce the amount of alcohol consumed to protect public health but alcohol consumption remains a prevalent feature of social interaction in the UK. Previous studies have identified a strong relationship between alcohol and social capital which varies in direction depending on the dimension of social capital studied. Using a large nationally representative longitudinal dataset for the UK, we apply an outcome-wide longitudinal design for causal inference, adjusting for covariates, as well as lagged values of outcome and exposure, to investigate if drinking less alcohol or not drinking alcohol at all is related to five binary social capital outcomes: socialising, being active in an organization, feeling lonely, number of close friends, and a bridging social capital score. We use two drinking exposures, binary drinker status, and categorised drinking frequency. We find that not drinking alcohol is negatively associated with socialising. Analysis using the frequency of drinking alcohol exposure finds drinking alcohol monthly or less is negatively associated with being active in an organisation. We find little evidence of any relationship between drinking alcohol and feelings of loneliness, number of friends and bridging social capital. Our results suggest that non-drinkers face barriers to some forms of social capital including socialising, which could be due to alcohol being a social norm in the UK. However, our results also suggest that high-frequency drinkers can reduce their drinking with minimal impact on their social capital. Our findings suggest more needs to be done to make socialising easier for non-drinkers. Furthermore, our findings support the implementation of policies to reduce high-frequency drinking.
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Affiliation(s)
- Benjamin Walker
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, UK
| | - Luke Munford
- Division of Population Health, Health Services Research & Primary Care, The University of Manchester, UK
- National Institute for Health and Care Research Applied Research Collaboration Greater Manchester (NIHR ARC-GM), UK
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Warran K, Wright LHV. Online 'chats': fostering communitas and psychosocial support for people working across arts and play for health and wellbeing. Front Psychol 2023; 14:1198635. [PMID: 37554138 PMCID: PMC10405829 DOI: 10.3389/fpsyg.2023.1198635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/29/2023] [Indexed: 08/10/2023] Open
Abstract
Loss of work, furlough, and increased social isolation were prevalent for many working in the broad context of cultural and community engagement for health and wellbeing. This study set out to explore if and how regular online group interactions may foster social cohesion and provide support for these individuals during the critical time of the COVID-19 global pandemic. It was conducted in the context of the 'social cohesion chat' series led by a network called the Arts Play Health Community which was initiated in response to the pandemic as a way to bring those working in or connected to arts, play and health together during times of social isolation. Two qualitative focus groups with creative, participatory components were conducted with artists, researchers, evaluators, and arts/play managers (n = 11), and then analyzed using thematic analysis. Researcher ethnographic reflections and fieldnotes were also collected and analyzed. The authors engaged in reflexive online discussions to integrate and synthesize findings across different data. Four themes were constructed through the analysis procedure: (1) 'Building an online community as processes of communitas', spotlighting the importance of the non-hierarchical structure of the 'chats' particularly in relation to there being 'no end goal' to the online dialogues; (2) 'Individual and shared emotional experiences' that underpinned feelings of connection to others and the online space; (3) 'Psychosocial benefits' such as improving confidence and providing an opportunity to 'have a voice' in the community; and (4) 'The importance of facilitation', highlighting the opportunities the chats provided for participants to feel validated and valued as an active member of the community. The article concludes that constructing an inclusive and welcoming online community, where active participation is at the heart of regular social interactions can provide support for those working across arts and play for health and wellbeing. This was particularly important during the societal turbulence of the COVID-19 pandemic. It further concludes by noting the unique structure of these online dialogues as not being connected to institutions, with this playing a key role in allowing those in the community to 'be themselves' within it.
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Affiliation(s)
- Katey Warran
- WHO Collaborating Centre for Arts and Health, Social Biobehavioural Research Group, Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, United Kingdom
- Edinburgh Centre for Research on the Experience of Dementia, School of Health in Social Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Laura H. V. Wright
- Children and Young People Thematic Hub, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, United Kingdom
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Baker RM, Ahmed M, Bertotti M, Cassidy J, Chipuriro R, Clewett E, Donaldson C, Elders A, Fenge LA, Fox J, Galway K, Gildea A, McGuinness A, McLean J, Manoukian S, Mason H, Morgan A, Mulholland J, O'Hare L, Paterson A, Porter S, Rendall J, Roy MJ, Seaman P, Simpson M, Steiner A, Kelly MP. Common health assets protocol: a mixed-methods, realist evaluation and economic appraisal of how community-led organisations (CLOs) impact on the health and well-being of people living in deprived areas. BMJ Open 2023; 13:e069979. [PMID: 36927592 PMCID: PMC10030928 DOI: 10.1136/bmjopen-2022-069979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION This research investigates how community-led organisations' (CLOs') use of assets-based approaches improves health and well-being, and how that might be different in different contexts. Assets-based approaches involve 'doing with' rather than 'doing to' and bring people in communities together to achieve positive change using their own knowledge, skills and experience. Some studies have shown that such approaches can have a positive effect on health and well-being. However, research is limited, and we know little about which approaches lead to which outcomes and how different contexts might affect success. METHODS AND ANALYSIS Using a realist approach, we will work with 15 CLOs based in disadvantaged communities in England, Scotland and Northern Ireland. A realist synthesis of review papers, and a policy analysis in different contexts, precedes qualitative interviews and workshops with stakeholders, to find out how CLOs' programmes work and identify existing data. We will explore participants' experiences through: a Q methodology study; participatory photography workshops; qualitative interviews and measure outcomes using a longitudinal survey, with 225 CLO participants, to assess impact for people who connect with the CLOs. An economic analysis will estimate costs and benefits to participants, for different contexts and mechanisms. A 'Lived Experience Panel' of people connected with our CLOs as participants or volunteers, will ensure the appropriateness of the research, interpretation and reporting of findings. ETHICS AND DISSEMINATION This project, research tools and consent processes have been approved by the Glasgow Caledonian University School of Health and Life Sciences Ethics Committee, and affirmed by Ethics Committees at Bournemouth University, Queen's University Belfast and the University of East London. Common Health Assets does not involve any National Health Service sites, staff or patients.Findings will be presented through social media, project website, blogs, policy briefings, journal articles, conferences and visually in short digital stories, and photographic exhibitions.
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Affiliation(s)
- Rachel Mairi Baker
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | | | - Marcello Bertotti
- Institute for Connected Communities, University of East London, London, UK
| | - John Cassidy
- Scottish Communities for Health and Wellbeing, Glasgow, UK
| | - Rejoice Chipuriro
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Emma Clewett
- Institute for Connected Communities, University of East London, London, UK
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Andrew Elders
- NMAHP Research Unit, Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK
| | - Lee Ann Fenge
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Julie Fox
- Annexe Communities Glasgow, Glasgow, UK
| | - Karen Galway
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Aideen Gildea
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | | | - Sarkis Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Antony Morgan
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Jill Mulholland
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Liam O'Hare
- Innovation Zones, School of Social Science, Education and Social Work, Queen's University Belfast, Belfast, UK
| | | | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Jack Rendall
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Michael J Roy
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Peter Seaman
- Glasgow Centre for Population Health, Glasgow, UK
| | | | - Artur Steiner
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Michael P Kelly
- Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Gough C, Barr C, Lewis LK, Hutchinson C, Maeder A, George S. Older adults' community participation, physical activity, and social interactions during and following COVID-19 restrictions in Australia: a mixed methods approach. BMC Public Health 2023; 23:172. [PMID: 36698158 PMCID: PMC9875767 DOI: 10.1186/s12889-023-15093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND With the increasing age of the global population, key components of healthy ageing including community, physical, and social participation continue to gain traction. However, management of the COVID-19 pandemic aimed to protect older adults and reduce the spread of the virus, this restricted community participation and reduced the opportunities for social interaction. METHODS This mixed methods study investigates community dwelling older adults' community participation; physical activity and social interaction prior to, during, and following the COVID-19 lockdown in Adelaide, Australia. Twenty-six community dwelling older adults were monitored over three time-points between November 2018 and October 2020, with Global Positioning Systems, accelerometry and self-reported diaries. In addition, nineteen participants completed semi-structured interviews. RESULTS Community participation varied across the three time points, with significant reduction in the number of trips taken out-of-home (p = 0.021), social interactions (p = 0.001) and sleep quality (p = 0.008) during restrictions. Five themes were identified to explain personal experiences of community participation during restrictions: (1) Reframing of meaning, (2) Redefining to maintain activities, (3) Revision of risk, (4) Reflection and renewal and (5) Future planning. CONCLUSION During COVID-19 the physical and social activities of community dwelling older adults changed. Services that support older adults to adapt their activities , considering their capacities and preferences, to facilitate community participation are required.
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Affiliation(s)
- Claire Gough
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Chris Barr
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Lucy K Lewis
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Claire Hutchinson
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Anthony Maeder
- grid.1014.40000 0004 0367 2697College of Nursing and Health Sciences, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia ,grid.1014.40000 0004 0367 2697Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Stacey George
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia. .,Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia. .,Caring Futures Institute, Flinders University, Adelaide, Australia.
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Moore A, Bertotti M, Hanafiah A, Hayes D. Factors affecting the sustainability of community mental health assets: A systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e3369-e3383. [PMID: 35900123 PMCID: PMC10087471 DOI: 10.1111/hsc.13929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/21/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Resources and activities offered by Voluntary, Community and Social Enterprise (VCSE) organisations could play a key role in supporting communities with their mental health. Whilst policy makers have become increasingly interested in using such asset-based approaches to improve mental health and well-being, the sustainability of these approaches remains underresearched. In this review, we explored the factors affecting the sustainability of community mental health assets. We conducted a systematic review of the literature using keywords based on three key terms: 'sustainability', 'mental health issues' and 'service provision'. Our search strategy was deployed in four electronic databases (MEDLINE, Web of Science, ASSIA and IBSS) and relevant websites were also searched. The literature search was conducted in November and December 2020 and yielded 2486 results. After title and abstract screening, 544 articles were subjected to full-text review. A total of 16 studies were included in a narrative synthesis. Studies included a broad range of community interventions and 30 factors affecting sustainability were identified across three sustainability levels: micro (individual), meso (organisational) and macro (local/national/global). Factors were discussed as barriers or facilitators to sustainability. A key barrier across all sustainability levels was funding (cost to individual participants, lack of available funding for VCSEs, economic uncertainty) whilst a key facilitator was connectedness (social connections, partnering with other organisations, linking with national public health systems). Nearly all articles included no definition of sustainability and the majority of factors identified here were at the meso/organisational level. As funding was found to be such a prevalent barrier, more research into macro level factors (e.g. government policies) is required.
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Affiliation(s)
- Anna Moore
- Evidence Based Practice Unit (EBPU)University College London and Anna Freud National Centre for Children and Families (AFNCCF)LondonUK
| | - Marcello Bertotti
- Institute for Connected Communities (ICC)University of East LondonLondonUK
| | - Ainul Hanafiah
- Institute for Connected Communities (ICC)University of East LondonLondonUK
| | - Daniel Hayes
- Evidence Based Practice Unit (EBPU)University College London and Anna Freud National Centre for Children and Families (AFNCCF)LondonUK
- Research Department of Behavioural Science and HealthInstitute of Epidemiology & Health Care, University College LondonLondonUK
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Ramadan N, Bonmatí-Tomas A, Juvinyà-Canal D, Ghaddar A. Online breast-feeding support groups as a community asset in Lebanon after Beirut explosion. Public Health Nutr 2022; 25:1-11. [PMID: 35094725 PMCID: PMC9991805 DOI: 10.1017/s1368980022000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Breast-feeding rates are unsatisfactory in Lebanon. Social media groups could play an important role in promoting breast-feeding in normal conditions and post crisis. The aim of this study is to identify breast-feeding challenges, facilitators and assets and to describe how community assets via social media could build community resilience to pandemic's and disaster's effects. DESIGN A two-phase qualitative content analysis was performed on posts and comments collected from a Facebook breast-feeding support group. Data were categorised into themes, categories and subcategories. SETTING Posts and comments retrieved from a Facebook breast-feeding support group in Lebanon during the month of August 2020. PARTICIPANTS Group members: mothers who breastfed, breast-feeding mothers and group admins that are lactation consultants. RESULTS In phase one, breast-feeding 'Challenges' identified were lack of support from peers and family, lack of supportive policies, lack of knowledge and maternal stress related to political instability, COVID-19 and economic crisis. 'Assets and facilitators' included community support and donations. In phase two, analysis revealed how assets were being used on social media platform to build community resilience post crisis, through access to social support in challenging times, community engagement, material resources and transformative potential. CONCLUSION Challenges faced during breast-feeding were diminished due to the support and assets received on a Facebook breast-feeding support group, and social media has been shown to be an important community asset implicated in empowering women to breastfeed and to build community resilience in moments of crisis.
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Affiliation(s)
- Nabiha Ramadan
- Lebanese International University, Mazraa, Beirut146404, Lebanon
- University of Girona, Girona17003, Spain
| | | | | | - Ali Ghaddar
- Lebanese International University, Mazraa, Beirut146404, Lebanon
- Observatory of Public Policies and Health, Beirut, Lebanon
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Lau YS, Malisauskaite G, Brookes N, Hussein S, Sutton M. Complements or substitutes? Associations between volumes of care provided in the community and hospitals. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1167-1181. [PMID: 34138375 PMCID: PMC8526459 DOI: 10.1007/s10198-021-01329-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 05/27/2021] [Indexed: 06/12/2023]
Abstract
Policymakers often suggest that expansion of care in community settings may ease increasing pressures on hospital services. Substitution may lower overall health system costs, but complementarity due to previously unidentified needs might raise them. We used new national data on community and primary medical care services in England to undertake system-level analyses of whether activity in the community acts as a complement or a substitute for activity provided in hospitals. We used two-way fixed effects regression to relate monthly counts of community care and primary medical care contacts to emergency department attendances, outpatient visits and admissions for 242 hospitals between November 2017 and September 2019. We then used national unit costs to estimate the effects of increasing community activity on overall system expenditure. The findings show community care contacts to be weak substitutes with all types of hospital activity and primary care contacts are weak substitutes for emergency hospital attendances and admissions. Our estimates ranged from 28 [95% CI 21, 45] to 517 [95% CI 291, 7265] community care contacts and from 34 [95% CI 17, 1283] to 1655 [95% CI - 1995, 70,145] GP appointments to reduce one hospital service visit. Primary care and planned hospital services are complements. Increases in community services and primary care activity are both associated with increased overall system expenditure of £34 [95% CI £156, £54] per visit for community care and £41 [95% CI £78, £74] per appointment in general practice. Expansion of community-based services may not generate reductions in hospital activity and expenditure.
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Affiliation(s)
- Yiu-Shing Lau
- Health Organisation, Policy and Economics, University of Manchester, Manchester, UK.
| | | | - Nadia Brookes
- Centre for Health Services Studies, University of Kent, Kent, UK
| | - Shereen Hussein
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics, University of Manchester, Manchester, UK
- Melbourne Institute: Applied Economic and Social Research, University of Melbourne, Melbourne, Australia
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Gough C, Lewis LK, Barr C, Maeder A, George S. Community participation of community dwelling older adults: a cross-sectional study. BMC Public Health 2021; 21:612. [PMID: 33781223 PMCID: PMC8008662 DOI: 10.1186/s12889-021-10592-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 03/08/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND With the advancing age of the population, and increasing demands on healthcare services, community participation has become an important consideration for healthy ageing. Low levels of community participation have been linked to increased mortality and social isolation. The extent to which community participation has been measured objectively in older adults remains scarce. This study aims to describe where and how older adults participate in the community and determine the feasibility of measurement methods for community participation. METHODS This observational cross-sectional study obtained data from 46 community dwelling older adults. A combination of Global Positioning Systems (GPS), accelerometry, and self-reported diaries were used over a 7-day monitoring period. Feasibility of methods were determined by calculating the loss of GPS data, questionnaires, and comparison of self-reported locations with GPS co-ordinates. Relationships between community participation, physical activity, social interactions, health related quality of life, sleep quality and loneliness were explored. RESULTS Older adults took a median (IQR) of 15 (9.25-18.75) trips out of home over the 7-day monitoring period, most frequently visiting commercial and recreational locations. In-home activities were mainly sedentary in nature, with out of home activities dependent on location type. Self-reported and GPS measures of trips out of home and the locations visited were significantly correlated (self-report 15.7 (5.6) GPS 14.4 (5.8) (r = 0.94)). Significant correlations between both the number of trips taken from home, with social interactions (r = 0.62) and the minutes of moderate to vigorous physical activity (MVPA) (r = 0.43) were observed. Daily MVPA was higher in participants who visited local walk/greenspaces (r = 0.48). CONCLUSION Participants performed more activities with social interactions out of home and visited commercial locations most frequently. The combination of GPS, accelerometry and self-report methods provided a detailed picture of community participation for older adults. Further research is required with older adults of varying health status to generalise the relationships between community participation, location and physical activity. TRIAL REGISTRATION Ethical approval was gained from the Flinders University Social and Behavioural Research Ethics Committee (protocol no. 8176).
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Affiliation(s)
- Claire Gough
- College of Nursing and Health Sciences, Flinders University, Sturt Building N219, GPO Box 2100, Adelaide, SA, 5001, Australia
- Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Lucy K Lewis
- College of Nursing and Health Sciences, Flinders University, Sturt Building N219, GPO Box 2100, Adelaide, SA, 5001, Australia
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Christopher Barr
- College of Nursing and Health Sciences, Flinders University, Sturt Building N219, GPO Box 2100, Adelaide, SA, 5001, Australia
- Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Anthony Maeder
- College of Nursing and Health Sciences, Flinders University, Sturt Building N219, GPO Box 2100, Adelaide, SA, 5001, Australia
- Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia
- Caring Futures Institute, Flinders University, Adelaide, Australia
| | - Stacey George
- College of Nursing and Health Sciences, Flinders University, Sturt Building N219, GPO Box 2100, Adelaide, SA, 5001, Australia.
- Flinders Digital Health Research Centre, Flinders University, Adelaide, Australia.
- Caring Futures Institute, Flinders University, Adelaide, Australia.
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Skevington SM, Rowland C, Panagioti M, Bower P, Krägeloh C. Enhancing the multi-dimensional assessment of quality of life: introducing the WHOQOL-Combi. Qual Life Res 2021; 30:891-903. [PMID: 33331967 PMCID: PMC7952286 DOI: 10.1007/s11136-020-02661-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION We revisited the global concept of subjective quality of life (QoL) as assessed by the WHOQOL-BREF to investigate whether it could be elaborated into a conceptually more comprehensive instrument with good psychometric properties. Responding to a growing need for shorter QoL measures with broader social, spiritual and environmental contents, facets from WHOQOL international modules were examined for potential integration into the new WHOQOL-Combi. METHOD Adults over 65 years, diagnosed with one or more chronic diseases (n = 2833), completed 41 WHOQOL items during the CLASSIC survey; each item represented a WHOQOL facet. This pool of specific QoL facets contained 24 from the WHOQOL-BREF (excluding general items), and 17 from recent international WHOQOL short-form modules, selected for their generic properties. Rasch modelling reduced the final item pool when assessing the WHOQOL-Combi's conceptual structure. Comparisons are made with the WHOQOL-BREF. RESULTS Modelling confirmed the tenability of a 36-item solution scored as a five-domain profile, comprised of 24 WHOQOL-BREF facets and 12 new facets from modules. Social and psychological domains were strengthened by three facets, spiritual QoL by five, and physical QoL by one. The WHOQOL-Combi showed sound model fit, excellent internal consistency (α = .95), and scores discriminated between socio-demographic categories. Concurrent validity with the EQ-5D-5L was confirmed for physical and psychological domains. Performance was similar to the WHOQOL-BREF. CONCLUSION The WHOQOL-Combi offers a contemporary, comprehensive, integrated, multi-dimensional subjective QoL instrument with enhanced evaluations of social, spiritual, psychological and physical QoL. Acceptable to older people, future research should evaluate younger age groups and other cultures.
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Affiliation(s)
- Suzanne M Skevington
- International Hub for Quality of Life Research, Manchester Centre for Health Psychology, Division of Psychological Science and Mental Health, University of Manchester, Manchester, M13 9PL, UK.
| | - Christine Rowland
- International Hub for Quality of Life Research, Manchester Centre for Health Psychology, Division of Psychological Science and Mental Health, University of Manchester, Manchester, M13 9PL, UK
| | - Maria Panagioti
- NIHR School for Primary Care Research, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Christian Krägeloh
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
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Community asset participation and social medicine increases qualities of life. Soc Sci Med 2020; 259:113149. [PMID: 32603958 PMCID: PMC7397510 DOI: 10.1016/j.socscimed.2020.113149] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/11/2020] [Accepted: 06/13/2020] [Indexed: 11/22/2022]
Abstract
Rationale Social prescribing to community assets, like social groups, is a current policy goal. As aging adults lead longer, healthier lives, the effects of participating in community assets raises questions about whether subjective quality of life (QoL) improves during participation and on what dimensions. Objective The study's goal was to examine the effectiveness of community assets at improving QoL among older people living in the community. Method Examining longitudinal survey data which tracked health and wellbeing in older adults living in Salford, UK over 12 months, we first used regressions on community assets to compare the World Health Organization's QoL Assessment (WHOQOL-BREF) domains at baseline for those who already participated in community assets (54%) and with non-participants (46%). Second, we used propensity score matching to compare QoL in an ‘uptake’ group (no initial participation but who participated at 12 months), to those who never participated, and to a ‘cessation’ group who participated initially, but ceased within one year, to those who always participated. Results Group comparisons confirmed that participants reported significantly higher QoL on all domains – environmental, psychological, physical, and social QoL – and on 16 predicted facets. After affirming group matching reliability, the strongest results were for the uptake group, with significant improvements in all domains, and in 18 facets. All QoL domains decreased in the cessation group, but overall, the effect was weaker. As predicted from the context, QoL relating to ‘opportunities for recreation and leisure’ showed the greatest effect. Furthermore, QoL increased with uptake, and decreased with cessation. Conclusion Policies to improve QoL in later life should be designed not just to promote community assets, but also maintain participation once initiated. Social prescribing to community assets such as social groups is now a policy goal. Little is known about their effect on participants' quality of life (QoL). Community asset participants reported higher QoL on all four domains. Participation uptake strongly led to increased QoL. Cessation was detrimental to QoL.
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13
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Munford LA, Wilding A, Bower P, Sutton M. Effects of participating in community assets on quality of life and costs of care: longitudinal cohort study of older people in England. BMJ Open 2020; 10:e033186. [PMID: 32034020 PMCID: PMC7045225 DOI: 10.1136/bmjopen-2019-033186] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Improving outcomes for older people with long-term conditions and multimorbidity is a priority. Current policy commits to substantial expansion of social prescribing to community assets, such as charity, voluntary or community groups. We use longitudinal data to add to the limited evidence on whether this is associated with better quality of life or lower costs of care. DESIGN Prospective 18-month cohort survey of self-reported participation in community assets and quality of life linked to administrative care records. Effects of starting and stopping participation estimated using double-robust estimation. SETTING Participation in community asset facilities. Costs of primary and secondary care. PARTICIPANTS 4377 older people with long-term conditions. INTERVENTION Participation in community assets. PRIMARY AND SECONDARY OUTCOME MEASURES Quality-adjusted life years (QALYs), healthcare costs and social value estimated using net benefits. RESULTS Starting to participate in community assets was associated with a 0.017 (95% CI 0.002 to 0.032) gain in QALYs after 6 months, 0.030 (95% CI 0.005 to 0.054) after 12 months and 0.056 (95% CI 0.017 to 0.094) after 18 months. Cumulative effects on care costs were negative in each time period: £-96 (95% CI £-512 to £321) at 6 months; £-283 (95% CI £-926 to £359) at 12 months; and £-453 (95% CI £-1366 to £461) at 18 months. The net benefit of starting to participate was £1956 (95% CI £209 to £3703) per participant at 18 months. Stopping participation was associated with larger negative impacts of -0.102 (95% CI -0.173 to -0.031) QALYs and £1335.33 (95% CI £112.85 to £2557.81) higher costs after 18 months. CONCLUSIONS Participation in community assets by older people with long-term conditions is associated with improved quality of life and reduced costs of care. Sustaining that participation is important because there are considerable health changes associated with stopping. The results support the inclusion of community assets as part of an integrated care model for older patients.
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Affiliation(s)
- Luke Aaron Munford
- Department of Health Organisation, Policy and Economics, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Anna Wilding
- Department of Health Organisation, Policy and Economics, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
| | - Matt Sutton
- Department of Health Organisation, Policy and Economics, Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester, UK
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Dare J, Wilkinson C, Marquis R, Donovan RJ. "The people make it fun, the activities we do just make sure we turn up on time." Factors influencing older adults' participation in community-based group programmes in Perth, Western Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:871-881. [PMID: 30027632 DOI: 10.1111/hsc.12600] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 04/03/2018] [Accepted: 05/31/2018] [Indexed: 06/08/2023]
Abstract
Rapid ageing in western societies is placing increasing strain on health and social care services. In response, governments and health agencies have sought to promote healthy ageing through a range of interventions, many of which aim to enhance social engagement and participation among older people. Such interventions are based on evidence that being socially engaged through participation in various activities leads to better physical, mental and psychosocial health outcomes. The research reported here employed focus groups and individual interviews to address research aims: (a) identify enablers and barriers to participation in community-based group activities among a sample of older people (n = 35, median age 71 years) living in a local government area in the northern suburbs of Perth, Western Australia, and (b) examine how these factors differ between those who regularly participate and those who do not. Our research highlighted four themes: Friendship and Function; Availability and Accessibility; Competing Responsibilities and Priorities; and Changing of the Guard. In particular, this research highlighted the importance of group activities in offering social support as a platform to develop friendships. The findings also indicated that opportunities for social interaction should be embedded in the structure of the group, beyond that which may occur incidentally during activities. This is important, given that while interest may motivate older people to join a group, a sense of belonging and connectedness generated through the group is more likely to maintain their attendance. Barriers included limited availability of local programmes, limited accessibility related to programme scheduling, and lack of programmes relevant to those who do not find traditional seniors' centres appealing. Recommendations include incorporating social engagement as an outcome measure when evaluating the efficacy of programmes targeting older people, and encouraging local governments to work with seniors' centres in developing activities attractive to a broader cohort of older people.
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Affiliation(s)
- Julie Dare
- Edith Cowan University, Joondalup, WA, Australia
| | - Celia Wilkinson
- Edith Cowan University, Joondalup, WA, Australia
- Curtin University, Bentley, WA, Australia
| | - Ruth Marquis
- Edith Cowan University, Joondalup, WA, Australia
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