A systematic review evaluating the psychometric properties of measures of social inclusion

Social exclusion as a major outcome domain of psychotic disorders: early predictors, and associations with non-recovery and clinical staging 21 years after a first episode of psychosis

PURPOSE

People with psychotic disorders have high levels of social exclusion; however, little is known about its early predictors. We present a long-term observational cohort study aimed at examining early risk factors for later social exclusion.

METHODS

A total of 243 subjects were assessed at their first psychotic episode for early risk factors including sociodemographic variables, familial risk of major mental disorders, perinatal complications, childhood factors, and adolescent factors and re-assessed after a mean follow-up of 21 years for 12 social exclusion domains: leisure activities, housing, work, income, neighborhood deprivation, educational attainment, physical and mental health, family and social support, legal competence, and discrimination. The ability of risk factors to predict social exclusion was examined using hierarchical linear regression.

RESULTS

Overall social exclusion was independently predicted by low parental socio-economic status, length of follow-up, familial risk of schizophrenia, obstetric complications, neurodevelopmental delay, poor childhood adjustment, childhood adversity, poor adolescent social networks, poor adolescent adjustment, and low premorbid IQ. The model explained 58.2% of the variance in total social exclusion score. Each social exclusion domain was predicted by a different set of variables, which explained between 17.8 and 57.0% of their variance, although low socio-economic status, familial risk of schizophrenia, obstetric complications, childhood adversity, and poor social networks predicted most of the social exclusion domains.

CONCLUSION

Early risk factors strongly predicted later social exclusion. A multifaceted approach to preventing later social exclusion is crucial in people with a first episode of psychosis and early risk factors of social exclusion.

Social inclusion programming for older adults living in age-friendly cities: a scoping review

OBJECTIVES

Creating age-friendly cities (AFCs) is essential for supporting older adults' well-being. The WHO's 2007 guide outlines key features of AFCs, including social inclusion. Despite increasing numbers of AFC programmes, diverse experiences of ageing are often overlooked. This scoping review explores innovative programmes implemented by AFCs to enhance social inclusion for older adults.

DESIGN

A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.

DATA SOURCES

Systematic searches were conducted between December 2023 and January 2024 across relevant databases (Ovid Medline, OVID Embase, OVID PsycINFO, CINAHL, Web of Science, Cochrane Library and Scopus) and the grey literature.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Selection criteria included English language publications describing evaluated age-friendly, social inclusion programmes for older adults.

DATA EXTRACTION AND SYNTHESIS

Data extraction followed Gonyea and Hudson's (2015) framework assessing programmes on population, environment and/or sector inclusion levels. Inductive analysis identified and evaluated aspects of social inclusion.

RESULTS

We identified 20 peer-reviewed publications and 18 grey literature sources. Most programmes (peer review, n=19, 95.0%; grey, n=18, 100.0%) addressed population inclusion, incorporated environment (peer review, n=10, 50.0%; grey, n=15, 83.3%) and/or sector inclusion (peer review, n=7, 35.0%; grey, n=15, 83.3%). Key outcomes included an improved sense of belonging, increased engagement with community resources and activities, enhanced digital literacy and connectivity, and a reduction in feelings of loneliness and isolation. A notable gap was the absence of studies focused on Indigenous populations.

CONCLUSION

We highlight that programmes addressing population, environment and sectoral inclusion may improve the well-being of older adults in urban settings. Our findings will inform AFC practices and policies by deepening our understanding of how social inclusion can be improved for older adults, including those from under-represented groups, ensuring an equitable approach to enhancing quality of life.

Social inclusion of children with autism spectrum disorders and mothers' mental health in two Arabic-speaking countries: a mediational model of culture and resilience

Objectives

Mothers of children with autism spectrum disorders (ASDs) have been reported to be more likely to experience lower levels of mental health as a result of the increased challenges associated with care provision and social inclusion of their children. Social inclusion in Arab countries differs in terms of quality and practices due to ecological and cultural variations. Based on an expected impact of culture and resilience, this study investigated the relationship between social inclusion practices and mothers' mental health in two Arabic-speaking countries.

Methods

A total sample of 660 mothers of children with ASD from Oman and Egypt participated in the study and were administered measures of perceived social inclusion practices, mental health, and resilience.

Results

Multi-group path analyses showed that culture and resilience have an impact on the association between social inclusion practices and mothers' mental health.

Conclusions

Our findings have significant implications for social inclusion practices. They underscore the need to build mothers' resilience to improve their mental health. Additionally, social inclusion practices need to be prioritized by policy makers and professionals in Arab countries in order to develop a model of best practices of social inclusion across Arab countries.

Shaping tomorrow's support: baseline clinical characteristics predict later social functioning and quality of life in schizophrenia spectrum disorder

PURPOSE

We aimed to explore the multidimensional nature of social inclusion (mSI) among patients diagnosed with schizophrenia spectrum disorder (SSD), and to identify the predictors of 3-year mSI and the mSI prediction using traditional and data-driven approaches.

METHODS

We used the baseline and 3-year follow-up data of 1119 patients from the Genetic Risk and Outcome in Psychosis (GROUP) cohort in the Netherlands. The outcome mSI was defined as clusters derived from combined analyses of thirteen subscales from the Social Functioning Scale and the brief version of World Health Organization Quality of Life questionnaires through K-means clustering. Prediction models were built through multinomial logistic regression (ModelMLR) and random forest (ModelRF), internally validated via bootstrapping and compared by accuracy and the discriminability of mSI subgroups.

RESULTS

We identified five mSI subgroups: "very low (social functioning)/very low (quality of life)" (8.58%), "low/low" (12.87%), "high/low" (49.24%), "medium/high" (18.05%), and "high/high" (11.26%). The mSI was robustly predicted by a genetic predisposition for SSD, premorbid adjustment, positive, negative, and depressive symptoms, number of met needs, and baseline satisfaction with the environment and social life. The ModelRF (61.61% [54.90%, 68.01%]; P =0.013) was cautiously considered outperform the ModelMLR (59.16% [55.75%, 62.58%]; P =0.994).

CONCLUSION

We introduced and distinguished meaningful subgroups of mSI, which were modestly predictable from baseline clinical characteristics. A possibility for early prediction of mSI at the clinical stage may unlock the potential for faster and more impactful social support that is specifically tailored to the unique characteristics of the mSI subgroup to which a given patient belongs.

What Measures are Effective in Trauma Screening for Young Males in Custody? A COSMIN Systematic Review

Despite the available evidence identifying the high prevalence rates of potentially traumatic experiences in forensic populations, there is still a lack of evidence supporting the use of suitable assessment tools, especially for young males in custody. For services to identify, support, and offer trauma interventions to this cohort, practitioners require reliable and valid assessment tools. This systematic review (Open Science Framework registration: https://osf.io/r6hbk) identifies those tools able to provide valid, reliable, and comparable data for this cohort. Five electronic databases and gray literature were searched to identify relevant measures. Inclusion criteria: studies of tools to assess for trauma with males aged between 12 and 25 years-old in a custodial setting, any year of publication, and available in English. Exclusion criteria: studies that did not measure psychological trauma or include a standalone trauma scale, or report primary data. A three-step quality assessment method was used to evaluate the methodological quality and psychometric properties of the measures. Fourteen studies were selected for review (which included 12 measures). The studies sampled a total of approximately 1,768 male participants and an age range of 12 to 25 years. The studies reported on various types of psychometric evidence and due to the lack of homogeneity, a narrative synthesis was used to discuss, interpret, and evaluate each measure. The overall quality of the psychometric properties of the measures in this review showed that the currently available instruments for the assessment of trauma with young males in custody is limited but promising.

The role of adolescent social inclusion in educational attainment among vulnerable youth

BACKGROUND

Completing high school enables access to educational and employment opportunities associated with better physical and mental health and improved quality of life. Identifying modifiable factors that promote optimal educational trajectories for youth experiencing disadvantage is an important research focus. Social inclusion has been theorised to play a role in promoting better educational outcomes for this priority population, however limited research has examined this relationship.

METHOD

This study used three waves of data from the state-representative Australian arm of the International Youth Development Study (IYDS) (youngest cohort, N = 733; 54% female, 95% Australian born) to examine the extent to which vulnerability in primary school (Grade 5; Mage = 10.97, SD = 0.38) and social inclusion in mid-adolescence (Year 10; Mage = 15.50, SD = 0.53), were associated with school completion in young adulthood (post-secondary; Mage = 19.02, SD = 0.43).

RESULTS

Regression models identified an interaction between social inclusion and vulnerability (OR = 1.37, 95% CI [1.06, 1.77], p = .016), indicating that the association between vulnerability and school completion varied as a student's level of social inclusion increased. Higher social inclusion was beneficial for youth with lower levels of vulnerability but did not appear to influence school completion for the most vulnerable students.

CONCLUSIONS

For many young people, promoting social inclusion may support engagement in education and play a protective role. However, further research is needed to better understand the role of social inclusion for highly vulnerable youth, particularly the mechanisms via which social inclusion may have differential effects on school completion.

Social identity and social integration: a meta-analysis exploring the relationship between social identity and social integration

Social identity formation is crucial for psychosocial development, particularly in the case of migrating adults. A body of research exploring how social identity influences social integration among migrants shows that social identity affects social integration through a range of moderators and procedures. This study reports on a meta-analysis of 33 studies with 47 cases (total N = 33,777; Fisher's z = 0.33, moderate effects) examining the relationship between social identity and social integration in research conducted from 2005-2020. The research findings suggest that social identity can affect social integration directly without any moderators, indicating that most of the identified moderators in the previous studies are sample-specific variables. More importantly, the effects of various aspects of identities exert similar degrees of impact (moderate effect) on social integration; in other words, the usefulness of analyzing different aspects of social identity on social integration is challenged.

School belonging and depressive symptoms: the mediating roles of social inclusion and loneliness

BACKGROUND

Loneliness and depressive symptoms are prevalent among Finns.

OBJECTIVES

This study, which analyzes nationwide data from 149,986 students aged 13-18 years in Finland, focuses on the mediating effects of social inclusion and loneliness in the association between school belonging and depressive symptoms.

METHOD AND RESULTS

The analysis of variance showed that boys reported higher levels of school belonging and social inclusion, whereas girls reported higher levels of loneliness and depressive symptoms. Mediation analysis showed that social inclusion and loneliness partially mediated the effect of school belonging on depressive symptoms, but that social inclusion's effect was much greater than loneliness's. By focusing on the moderating role of sex, it was discovered that social inclusion significantly mediated depressive symptoms in girls more than boys.

CONCLUSION

The importance of social inclusion in preventing depressive symptoms was highlighted in the discussion.

Association of social integration with cognitive function trajectories among Chinese older adults: evidence from the China health and retirement longitudinal study (CHARLS)

Background

The prevalence of cognitive impairment among older adults remains high. It has been proven that social integration is related to cognitive function. However, limited research has examined the association of social integration and its different dimensions with cognitive function trajectories of older adults.

Methods

The data were from the China Health and Retirement Longitudinal Study (CHARLS) spanning 2013 (T1) to 2018 (T3). A total of 3,977 older adults were included in the final analysis. Cognitive function was measured with items from an adapted Chinese version of the Mini-Mini-Mental Mental State Examination (MMSE), while the measurement of social integration included three dimensions: economic integration, relational integration and community integration. A group-based trajectory model (GBTM) was used to identify cognitive trajectory groups among participants and an unordered multinomial logistic regression was employed to explore the association of baseline social integration and its three dimensions with cognitive function trajectories.

Result

Three cognitive function trajectory groups were identified: low-decline group (24.1%), medium-decline group (44.2%) and high-stable group (31.7%). Comparing to the medium-decline trajectory group, older adults with higher social integration scores were more likely to be in the high-stable trajectory group (OR = 1.087, 95%CI: 1.007 ~ 1.174), while less likely to be in the low-decline group (OR = 0.806, 95%CI: 0.736 ~ 0.882). Among the different dimensions of social integration, older adults with higher community integration scores were more likely to be in the high-stable trajectory group (OR = 1.222, 95%CI: 1.026 ~ 1.456); Older adults with higher relational integration scores were less likely to be in the low-decline trajectory group (OR = 0.816, 95%CI: 0.734 ~ 0.906). The economic integration was not found to correlate with the cognitive function trajectories. Stratified analyses revealed that the association between community integration and cognitive trajectories was only significant among older adults aged 60 to 69, and the association between relational integration and cognitive trajectories was only significant among older adults who was agricultural household registration.

Conclusion

The developmental trajectories of cognitive function among Chinese older adults are heterogeneous. Social integration is significantly related to the trajectories of cognitive function in Chinese older adults. Measures should be taken to promote social integration of Chinese older adults to reduce the decline of cognitive function.

Modeling Adolescent Social Inclusion to Improve School Completion

Enhancing social inclusion in young people could increase engagement in education, yet few longitudinal studies have examined this relationship. This study aimed to identify whether social inclusion in an Australian adolescent sample predicted high school completion three years later. Using state-representative data from the International Youth Development Study, two waves of the youngest cohort (51.6% female and 94.6% Australian born) during mid-adolescence (n = 825, M_age = 15.99, SD = 0.39) and post-secondary school (n = 809, M_age = 19.03, SD = 0.44) were analyzed. Factor analysis identified a 4-factor structure that represented an overarching social inclusion construct: (1) Citizenship, (2) Connectedness to Community, (3) Connectedness to Family, and (4) Connectedness to and Participation in School. Multivariate regression analyses indicated higher social inclusion levels in mid-adolescence predicted an increased likelihood of high school completion three years later. The implementation of strategies that incorporate the enhancement of social inclusion may improve educational outcomes for young people.

Social inclusion of refugees and asylum seekers: The role of public libraries in the Lisbon Metropolitan Area

Social inclusion of refugees and asylum seekers includes addressing their information needs. This research seeks to examine the role of public libraries in this process through the analysis of public librarians’ perceptions. Based on the constructivist paradigm, the case study method, and the semi-directive interview survey technique, 16 public municipal libraries in the Lisbon Metropolitan Area (Portugal) are studied. The results highlight that these libraries do not identify forced migrants as their users. Still, they consider that the information needs and behaviors and the use of libraries by these communities are similar to those of economic migrants, with emphasis on the relevance of free access to the internet, foreign language resources, Portuguese language and digital literacy courses, and help to interact with online platforms. The gaps include the existence of few Portuguese courses for foreigners, a limited practice in assisting with job and housing searches, promoting health literacy, and inclusive collaboration with schools, as well as space, financial, and human resources constraints. To overcome these difficulties, librarians emphasize the motivation to fulfill the inclusive social mission of the public library, the universal accessibility and informal environment of the library, and its action to promote social cohesion and social capital. The respondents consider that the mission of public libraries is adjusted to the goal of social inclusion of forced migrants, but that there is room for improvement in the training of librarians. This research points to the need for more initiative-taking public library collaboration with existing inclusion networks. In conclusion, we seek to alert to the urgency of the involvement of Portuguese public libraries in the social inclusion of forced migrants, which will also contribute to their institutional legitimization.

Health-Related Quality of Life in People Living With HIV With Cognitive Symptoms: Assessing Relevant Domains and Associations

This study aimed to validate and assess a comprehensive set of illness-specific health-related quality of life (HRQL) domains in people living with HIV (PLWH) with cognitive symptoms. One hundred and three HIV patients with cognitive symptoms (n = 93 male, 90.3%) were identified from two UK HIV clinics and complete a series of validated scales measuring seven HRQL domains identified as important to HRQL by PLWH with cognitive impairment. These included: physical functioning, cognition, social connectedness, self-concept, HIV stigma, acceptance of and perceived control over cognitive health, and physical and mental health and wellbeing. Exploratory factor analysis confirmed that domain total scores loaded onto one main factor, representing HRQL. Scale cut-off scores revealed a significant proportion of patients scored outside the normal range on single domains (between 26.2% and 79.6%), and many patients on multiple domains (40.8% on 4 or more domains). We found evidence of poor HRQL across domains in the majority of PLWH with cognitive symptoms and identified domains driving these experiences. This provides targets for intervention development and clinical action to maintain or improve HRQL in PLWH with cognitive symptoms or impairment.

A social network analysis of interorganisational collaboration: Efforts to improve social connectedness

The Covid-19 pandemic has challenged public health practitioners and clinicians at multiple levels to intentionally consider the impact of social isolation on health outcomes. Many community-based programmes design interventions to address tangible challenges within the social determinants of health, such as asset insecurity or food insecurity, to address health inequities. The growing need to address social isolation within marginalised communities also requires organisations to collaborate and create community partnerships that strengthen their own social integration within the community. The present research reports on the results of a Social Network Analysis (SNA) of community programmes within three southern U.S. cities and their local collaborations to address social isolation. After interviewing representatives of 46 community organisations, it was found that social service organisations that also offer public health services play a central role in community efforts to improve social isolation. The participating organisations primarily collaborate through referrals and information sharing, and report inadequate resources. With a growing recognition that social services and supports play a considerable role in addressing health inequities, this study provides evidence of opportunities for interorganisational collaboration to promote individual and community health.

Perceived Discrimination and Mental Health: The Role of Immigrant Social Connectedness during the COVID-19 Pandemic

The COVID-19 public health emergency has led to changes in people's attitudes towards minority groups, increasing prejudice and discriminatory behaviors, especially towards migrants. These prejudicial attitudes and discrimination negatively influence migrants' mental health increasing anxiety and depression and loneliness. However, the sense of belonging can be beneficial in mitigating these mental health issues especially in adverse social situations. Within this context, the aim of the study was to examine to what extent overall social connectedness plays a role in immigrant mental health during the COVID-19 crisis, hypothesizing that reduced sense of belonging to the social world will be part of the pathway from the negative effects of perceived discrimination on mental health during the pandemic. We recruited 104 immigrants from Greece who completed online self-report measures of perceived discrimination, social connectedness, depression, anxiety, paranoia, and loneliness, and conducted mediation analyses to test our predictions. Mediation models indicated that perceived discrimination has a negative impact on sense of belonging, which in turn increases anxiety and paranoia symptoms. Findings suggest that while perceived discrimination has a negative impact on mental health, this effect is less severe if participants remain socially connected. Results are discussed with regard to the need for social inclusion practices.

Healthy ageing through participation in community situated activities: A scoping review of assessment instruments to support occupational therapy practice

INTRODUCTION

The occupational therapy profession has an essential role to play in healthy ageing that includes enabling participation, a construct that according to The International Classification of Functioning, Disability and Health (ICF), incorporates an environmental context. Environmental barriers and enablers of participation in community-situated activities for people over the age of 65 have been identified. To support practice, occupational therapists require assessments with demonstrated content validity including comprehensive coverage of the construct. The purpose of this scoping review study was to investigate what instruments are available to assess community participation for people over the age of 65 that included environmental factors.

METHODS

A scoping review of the literature was conducted, utilising the Joanna Briggs Institute (JBI) scoping review methodology. The evidence source was review articles and inclusion criteria were that they reviewed instruments to assess participation that could be used for people over the age of 65. Items extracted from included instruments were evaluated against a preset list of community-participation and environment categories that had been developed from the ICF.

RESULTS

Twenty-three review studies met inclusion criteria and from these 240 instruments were extracted. Twenty instruments were retained after exclusions and from these, 540 instrument items were extracted. Of these, 280 (47%) were coded as community-participation, and only 20 (3.4%) as environment items. Fourteen of the instruments included no environment items.

CONCLUSIONS

No instrument was identified that comprehensively assessed community participation including the related environmental factors. Such an instrument is required to enable occupational therapy practitioners to support healthy ageing. The development of such an instrument will strengthen the profession's capacity to develop new ways of delivering services to older adults in line with emerging ways that aged care will be delivered and to advance its essential role in healthy ageing.

Social connectedness, mindfulness, and coping as protective factors during the COVID-19 pandemic

The COVID-19 pandemic has had an unprecedented psychological impact, revealing immense emotional disturbances among the general population. This study examined the extent to which social connectedness, dispositional mindfulness, and coping moderate symptoms of anxiety and depression in 1242 adults under the same government-issued COVID-19 stay-at-home mandate. Participants completed measures of anxiety, depression, dispositional mindfulness, social connectedness, and coping, and regression analyses were used to examine associations and interaction effects. Results indicated that social connectedness and dispositional mindfulness were associated with reduced symptoms. For individuals living with a partner, decreased mindfulness and avoidant coping were associated with anxious symptoms. In households with children, overutilization of approach coping served to increase symptoms of depression. Results indicate the importance of considering social connectedness, mindfulness, and coping in counseling to enhance factors serving to protect clients during a public health crisis. Implications for professional counselors and areas of future research are discussed.

Developing a tool for the measurement of social exclusion in healthcare settings

Background

Social exclusion is a complex concept that is recognised as a key determinant of health. Many measurement tools developed looked at people from single excluded groups in isolation. We know from experience and literature that exclusion is often intersectional and multi-layered. Therefore, the aim of this research was to develop a social exclusion measurement tool for use in healthcare settings with individuals from any excluded group that would include questions to investigate socioeconomic elements and subjective experiences in their lives.

Methods

Inductive and deductive methods were used to develop the tool. Early drafts were tested with experts (both academic and experts by experience) and modified in line with feedback received. The tool was then piloted with people in the community, and this allowed us to assess the internal consistency and validity of the tool. Exploratory factor analysis was carried out as part of this evaluation.

Results

The measurement tool was initially evaluated by 17 academic and ‘real world’ experts. It was then piloted with seven experts by experience, two gatekeepers and two participants who were presumed not to be excluded, resulting in the development of the final tool. This was then tested with 276 participants (127 presumed excluded, 149 presumed not excluded). The socioeconomic characteristics of these participants were documented, and exploratory factor analysis was carried out on data relating to subjective items. A four-factor structure emerged comprising 22 items. Internal consistency of the factors was high, and their ability to discriminate between the two groups was notable.

Conclusions

A tool for measuring the social exclusion of individuals has been developed by engaging with people from a variety of excluded groups. Socioeconomic indicators were combined with subjective items. The input of experts by experience, academics and others was sought to enhance the tool. The tool was applied to two distinct samples, showing obvious differences both in the socioeconomic items, and the items included in the factor analysis. The potential use of this tool could have positive implications for people who are excluded.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-022-01636-1.

Psychometric properties of a brief, self-report measure of social inclusion: the F-SIM16

AIMS

A disproportionate number of people with mental ill-health experience social exclusion. Appropriate measurement tools are required to progress opportunities to improve social inclusion. We have developed a novel measure, the Filia Social Inclusion Measure (F-SIM). Here we aimed to present a more concise, easy-to-use form, while retaining its measurement integrity by (i) refining the F-SIM using traditional and contemporary item-reduction techniques; and (ii) testing the psychometric properties of the reduced measure.

METHODS

Five hundred and six participants completed the F-SIM, younger and older groups of people with serious mental illness (including psychosis, mood, anxiety disorders) and same-aged community counterparts. The F-SIM was completed at baseline and 2-week follow-up, alongside other measures (including social inclusion, loneliness). The F-SIM was refined using multidimensional scaling network analysis, confirmatory factor analysis and item response theory. The psychometric evaluation included assessment of dimensionality, internal consistency, test-retest reliability, discriminant ability and construct validity.

RESULTS

The F-SIM was reduced from 135-items to 16; with 4-items in each domain of housing and neighbourhood, finances, employment and education and social participation and relationships. Psychometric properties were sound, including strong internal consistency within domains (all α > 0.85) and excellent overall (α = 0.92). Test-retest reliability was also high (γ = 0.90). Differences between groups were observed; clinical subgroups consistently reported lower levels of social inclusion compared to community counterparts.

CONCLUSIONS

The F-SIM16 is a sound, reliable, brief self-report measure of social inclusion suitable for use in clinical and research settings. It has the potential to evaluate the effectiveness of interventions, and aid in fostering targeted and personalised needs-based care.

The impact of physical activity and sport programs on community participation for people with intellectual disability: A systematic review

ABSTRACTBackground: This review examined the impact of participation in an intentional physical activity or sport program on community participation and inclusion for people with intellectual disability.Method: Five electronic databases (PsychINFO, PubMed, Medline, CINAHL, AMED) were systematically searched for papers relating to intellectual disability, intentional physical activity, and community inclusion.Results: There were nine eligible papers reporting on seven unique studies conducted in North America, Europe and Australia. Interventions ranged from Special Olympics to an exercise and health education program. Peers without intellectual disability were involved in several programs, and the development of friendships was common among participants with and without disability: these were rarely transferred to the wider community.Conclusions: The identified programs involved substantial commitment of people and infrastructure to support people with intellectual disability in intentional physical activity programs. There was little evidence these programs improved community participation and inclusion for people with intellectual disability.

"There is people like us and there is people like them, and we are not like them." Understating social exclusion - a qualitative study

Social exclusion is a complex concept that is relevant in terms of the health of vulnerable groups. Attempts have been made in the past to measure it, both at the population and the individual level. The aim of this research was to engage with a broad range of relevant stakeholders in Ireland in order to learn how they defined and conceptualised social exclusion. Semi-structured interviews were carried out with 24 participants selected using maximum variation sampling. One quarter of the interviewees were experts by experience. Participants included academic experts, the heads of organisations working nationally with socially excluded groups, politicians, clinicians, support workers and health service managers all with experience of working with socially excluded groups. The resulting definition of social exclusion was “the experience of lack of opportunity, or the inability to make use of available opportunities, thereby preventing full participation in society.” From this, we developed a new model of the concept comprising three elements; Opportunities, Influencing factors and Social outcomes. Opportunities are the fundamental needs that are required to be met for a person to begin leaving social exclusion. Influencing factors are a mixture of the personal characteristics and more complex problems such as the intergenerational effects of disadvantage. Social outcomes include a person being accepted by wider society, and subsequently being able to participate. The conceptual framework we developed can contribute to a better understanding of the concept of social exclusion. The traditional policy focus on improving the needs of excluded people at the Opportunities level must continue, but must be complemented by tackling the problems at the levels of the Influencing factors and Social outcomes also. In terms of changes to practice, the measurement of the social exclusion status of people engaging with primary care and other services would be an important start in order to better understand the magnitude of the work required.

Social participation of people with chronic wounds: A systematic review

Living with chronic ulcers can be burdensome and restrictive, with regard to not only physical and psychological but also social well-being. This review aims to analyse social participation in patients with chronic wounds and to compare results across different wound types. A search string was applied in several electronic databases. Results were screened according to predefined inclusion and exclusion criteria. Data of eligible articles were extracted and synthesised narratively. The search revealed 42 eligible publications. Only minor differences across different ulcer types could be detected. Overall, family members were the main social contacts for patients; they often provided wound care and emotional support. Patients had few non-family relations, but those existing were often very close. Patients felt guilty as their condition imposed burden on family and friends, as well. A close relationship with nurses was described. Restrictions were caused by direct and indirect consequences of the wound. Overall, social support and social connections were reduced in wound patients. Inconsistent results were found regarding social isolation. In summary, people with chronic wounds experience impairments in all aspects of social participation. Therefore, social participation deserves increased attention in routine care both as a trigger of burden and as an outcome of therapy.

Social inclusion of students with special educational needs assessed by the Inclusion of Other in the Self scale

How does the participation of students with special educational needs (SEN) in mainstream education affect their social inclusion? We introduce a single-item pictorial measure, the Inclusion of Other in the Self (IOS), to compare the social inclusion of SEN students attending mainstream regular schools to social inclusion of SEN students attending special schools. We collected responses from 138 parents of SEN students aged 4–20, to obtain data on the loneliness, friendships and social inclusion of SEN students. The parents of SEN students attending regular schools did not perceive their children to be less included than parents of SEN students attending special schools. School context decreased SEN students’ perceived loneliness independent of the school type. And while most SEN students’ friendships were formed at school, SEN students attending regular schools had more friends, and these were more likely to live in the same neighborhood. Overall, the social inclusion of SEN students across school types was not affected by the school type, only by the school’s inclusive characteristics.

Development of the workplace inclusion questionnaire (WIQ)

Aims:

To develop a questionnaire to examine attitudes among employees and managers to include people with various health problems into their work group, and to test the questionnaire in one relevant population within the labour market.

Methods:

A questionnaire was developed through a process involving discussions in a scientific forum and pilot testing with group discussions. The final questionnaire, which was tested in a survey study of managers and employees in 33 Norwegian kindergartens (N=485), contained 10 short case stories followed by questions concerning workplace inclusion. The case stories described individuals with musculoskeletal and mental disorders, as well as individuals with potentially stigmatising behavioural history and lifestyle, and control cases. Risk ratios with 95% confidence intervals (CIs) were used to compare the case stories. Cases with high risk ratios had an increased risk of not being included compared to a control case.

Results:

Attitudes for workplace inclusion varied between the different case stories. Cases portraying mental illness had the highest risk ratios, indicating that employees and managers are less likely to include people with mental illness than people with musculoskeletal illness. Furthermore, unspecific or chronic illness had higher risk ratios than specific and acute illness. The most important barriers also varied between case stories.

Conclusions:

The workplace inclusion questionnaire fulfills the need for a quantitative measure of attitudes to include individuals with various health problems into the workplace. Comparison of risk ratios showed clear differences between case stories, indicating that the workplace inclusion questionnaire is a valuable tool to measure the variance in workplace inclusion.

Examining the Relationship between Social Connection and Opioid Misuse: A Systematic Review

METHODS

We used a Boolean search strategy of PubMed, PsycINFO, and Embase to identify eligible publications from January 1990 to March 2020 and narrative analysis to synthesize the evidence.

RESULTS

The database search identified 1267 independent citations; 29 publications met inclusion criteria. Nearly all the studies demonstrated high risk of bias, most often due to selection and confounding bias. Most of the studies in the review (k = 20, 69%) found at least one significant association between social connection and opioid outcomes. Although no two studies included the same measures of social connection or opioid misuse, and social connection was both positively and negatively associated with opioid misuse, results support that social connection is an important correlate of opioid misuse.

CONCLUSIONS

This review highlights the importance of social connection as a correlate to opioid misuse. However, the extensive variability among research studies points to a need for standardization of measurement and larger studies with diverse populations to allow for consequential recommendations for prevention or treatment of opioid misuse. Evidence regarding the associations between social connection and opioid misuse or disorder is sparse. We provide suggestions for advancing this research, including clarification of the complex influences between social connections and opioid misuse.

Testing the Efficacy of a Multicomponent, Self-Guided, Smartphone-Based Meditation App: Three-Armed Randomized Controlled Trial

BACKGROUND

A growing number of randomized controlled trials (RCTs) suggest psychological benefits associated with meditation training delivered via mobile health. However, research in this area has primarily focused on mindfulness, only one of many meditative techniques.

OBJECTIVE

This study aims to evaluate the efficacy of 2 versions of a self-guided, smartphone-based meditation app-the Healthy Minds Program (HMP)-which includes training in mindfulness (Awareness), along with practices designed to cultivate positive relationships (Connection) or insight into the nature of the self (Insight).

METHODS

A three-arm, fully remote RCT compared 8 weeks of one of 2 HMP conditions (Awareness+Connection and Awareness+Insight) with a waitlist control. Adults (≥18 years) without extensive previous meditation experience were eligible. The primary outcome was psychological distress (depression, anxiety, and stress). Secondary outcomes were social connection, empathy, compassion, self-reflection, insight, rumination, defusion, and mindfulness. Measures were completed at pretest, midtreatment, and posttest between October 2019 and April 2020. Longitudinal data were analyzed using intention-to-treat principles with maximum likelihood.

RESULTS

A total of 343 participants were randomized and 186 (54.2%) completed at least one posttest assessment. The majority (166/228, 72.8%) of those assigned to HMP conditions downloaded the app. The 2 HMP conditions did not differ from one another in terms of changes in any outcome. Relative to the waitlist control, the HMP conditions showed larger improvements in distress, social connectedness, mindfulness, and measures theoretically linked to insight training (d=-0.28 to 0.41; Ps≤.02), despite modest exposure to connection- and insight-related practice. The results were robust to some assumptions about nonrandom patterns of missing data. Improvements in distress were associated with days of use. Candidate mediators (social connection, insight, rumination, defusion, and mindfulness) and moderators (baseline rumination, defusion, and empathy) of changes in distress were identified.

CONCLUSIONS

This study provides initial evidence of efficacy for the HMP app in reducing distress and improving outcomes related to well-being, including social connectedness. Future studies should attempt to increase study retention and user engagement.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04139005; https://clinicaltrials.gov/ct2/show/NCT04139005.

Social inclusion level of Spanish and foreign adolescents: Proposal for an evaluation instrument

Social exclusion is one of the most complex and sensitive social problems nowadays. Of all social groups, adolescents are among the most vulnerable to social exclusion, which can interfere with their social development. Consequently, the evaluation of this construct in adolescents is an important matter. The aim of this investigation was to develop the Social Inclusion for Adolescents Scale (SIAS). Firstly, five psychosocial factors were proposed, which potentially contribute to social inclusion: (1) covered needs, (2) self-efficacy, (3) social support, (4) job training, and (5) social integration. From these five factors, a set of items was created and reduced using qualitative evaluations. The final set of items was used in three studies, with a Spanish population (N = 1540) and a foreign population (N = 460), to test the psychometric properties of the scale, its dimensional structure, the measurement invariance between Spanish and foreign people, the reliability of the instrument and the evidence of the validity of its measurements. The results indicate that this scale is psychometrically reliable enough to assess social inclusion in adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-020-01201-5.

Validation of the Korean version of the Kidney Transplant Understanding Tool

PURPOSE

Because there are no new and validated tools that assess knowledge of kidney transplant (KT), we aimed to construct the Korean version of the Kidney Transplant Understanding Tool (K-TUT) and to validate it.

METHODS

The Korean version of the K-TUT was established based on a translation and cultural adaptation process. A total of 69 items were reviewed by eight experts in KT for content validity, and a quantitative analysis was used to assess convergent and criterion validity (correlation coefficients), internal consistency (Kuder-Richardson 20, KR-20), test-retest reliability (intraclass correlation coefficient, ICC), item difficulty, and item discrimination for 29 KT candidates and 91 KT recipients.

RESULTS

The content validity of the Korean version of the K-TUT proved to be excellent as all items; the scale-level content validity index (S-CVI) in universal average was .86 and the S-CVI in average was .98. A positive association between the scores assessed by the Korean version of the K-TUT and knowledge level of KT (r = .74 for KT candidates and r = .57 for KT recipients, both p < .001) and treatment adherence (r = .31, p = .003) was shown. The overall ICC values are .91 for KT candidates and .88 for KT recipients. The KR-20 values were .89‒.94 for KT candidates and .76‒.78 for KT recipients. The mean difficulty and discrimination were .72 and .41 for KT candidates, and .76 and .33 for KT recipients.

CONCLUSION

The Korean version of the K-TUT is proved to be a valid and reliable tool to assess KT-related knowledge in both KT candidates and recipients.

Measures of Workplace Inclusion: A Systematic Review Using the COSMIN Methodology

Purpose To systematically assess the measurement properties and the quality of the evidence for measures of inclusion or exclusion at work. Methods Comprehensive searches of five electronic databases were conducted up to February 2019. Eligible studies aimed to develop a measure of workplace inclusion or exclusion or assessed at least one measurement property. Pairs of reviewers independently screened articles and assessed risk of bias. Methodological quality was appraised with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. A best-evidence synthesis approach guided the analysis. For each measurement property, evidence quality was rated as high, moderate, low, or very low and results were classified as sufficient, insufficient, or inconsistent. Results The titles and abstracts of 14,380 articles were screened, with 151 full-text articles reviewed for eligibility. Of these, 27 studies were identified, 10 of which were measure development studies. Included measures were the Workplace Ostracism Scale, Ostracism Interventionary Behaviour Scale, Workplace Culture Survey, Workplace Exclusion Scale, Perceived Group Inclusion Scale, Organizational Cultural Intelligence Scale, Inclusion-Exclusion Scale, Climate for Inclusion Scale, Workplace Social Inclusion Scale and the Inclusion-Diversity Scale. Most workplace inclusion instruments were not examined for some form of validity or reliability and evidence for responsiveness was absent. The quality of the evidence for content validity was low for 30% of studies and very low for 70% of studies. Conclusion Future research should focus on comprehensive evaluations of the psychometric properties of existing measures, with an emphasis on content validity, measurement error, reliability and responsiveness.

Development and validation testing of a weight management nutrition knowledge questionnaire for adults

Background/Objectives

Because no validated tool exists to assess nutrition knowledge regarding weight management we developed and tested the Weight Management Nutrition Knowledge Questionnaire (WMNKQ).

Subjects/Methods

The questionnaire assesses nutrition knowledge in these categories: energy density of food, portion size/serving size, alcohol and sugar sweetened beverages, how food variety affects food intake, and reliable nutrition information sources. In total 60 questions were reviewed by 6 experts for face validity and quantitative analysis was used to assess item difficulty, item discrimination, internal consistency, inter-item-correlation, test-retest reliability, construct validity, criterion validity, and convergent validity.

Results

The final WMNKQ contained 43 items. Experts removed 3 of the original 60 questions and modified 41. Eighteen items did not meet criteria for item difficulty, item discrimination, and/or inter-item correlation; 4 were retained. The WMNKQ met criteria for internal consistency (Cronbach's alpha = 0.88), reliability (test-retest correlation ρ = 0.90, P < 0.0001), construct validity (known groups comparison) - dietitians scored 16% better (p < 0.0001) than information technology workers, and criterion validity (pre- to post-intervention improvement in knowledge scores = 11.2% (95% CI 9.8–12.5, p < 0.0001)). Participants younger than age 55 scored significantly better than those over age 55 (convergent validity).

Conclusions

The WMNKQ measures how well nutrition principles of weight management are understood.

Validity, reliability, acceptability, and utility of the Social Inclusion Questionnaire User Experience (SInQUE): a clinical tool to facilitate social inclusion amongst people with severe mental health problems

BACKGROUND

Individuals with severe mental health problems are at risk of social exclusion, which may complicate their recovery. Mental health and social care staff have, until now, had no valid or reliable way of assessing their clients' social inclusion. The Social Inclusion Questionnaire User Experience (SInQUE) was developed to address this. It assesses five domains: social integration; productivity; consumption; access to services; and political engagement, in the year prior to first psychiatric admission (T1) and the year prior to interview (T2) from which a total score at each time point can be calculated.

AIMS

To establish the validity, reliability, and acceptability of the SInQUE in individuals with a broad range of psychiatric diagnoses receiving care from community mental health services and its utility for mental health staff.

METHOD

Participants were 192 mental health service users with psychosis, personality disorder, or common mental disorder (e.g., depression, anxiety) who completed the SInQUE alongside other validated outcome measures. Test-retest reliability was assessed in a sub-sample of 30 participants and inter-rater reliability was assessed in 11 participants. SInQUE ratings of 28 participants were compared with those of a sibling with no experience of mental illness to account for shared socio-cultural factors. Acceptability and utility of the tool were assessed using completion rates and focus groups with staff.

RESULTS

The SInQUE demonstrated acceptable convergent validity. The total score and the Social Integration domain score were strongly correlated with quality of life, both in the full sample and in the three diagnostic groups. Discriminant validity and test-retest reliability were established across all domains, although the test-retest reliability on scores for the Service Access and Political Engagement domains prior to first admission to hospital (T1) was lower than other domains. Inter-rater reliability was excellent for all domains at T1 and T2.

CONCLUSIONS

The component of the SInQUE that assesses current social inclusion has good psychometric properties and can be recommended for use by mental health staff.

Social inclusion as a tool to improve rural health

Health inequalities between metropolitan and rural areas persist despite a range of interventions over recent years. Social inclusion is often linked to health outcomes, yet few studies examine social inclusion across different geographic areas. In this study, a set of indicators of social inclusion were drawn together and sourced data were aligned to these indicators, which are readily available to primary health practitioners and population health planners. Through this process, a useful framework that provides a nuanced understanding to guide primary health policy and practice has been produced. Using Victoria as an example, 11 domains of social inclusion were explored using population data across 79 local government areas. Analysis highlighted significant differences in several indicators, with rural and regional local government areas ranking higher on measures of social participation, trust and social resources. The use of a diversity of data sources provided information on the social, economic, and education issues of an area, along with relational factors such as safety, trust, community resources and civic participation. A social inclusion lens can inform action to address the rural-urban primary health divide by determining and exploring the social inclusion characteristics of communities.

Group differences in social inclusion between young adults aged 18 to 25 with serious mental illness and same-aged peers from the general community

AIMS

Young adults with serious mental illness (SMI) are thought to be socially excluded. However, psychometric measures of social inclusion have not been employed to examine group differences relative to peers from the general community. The aim of this study was to employ such a measure to determine differences in social inclusion between young adults with SMI and peers from the general community.

METHODS

A cross-sectional hierarchical logistic regression was conducted to identify which dimensions and individual indicators from the Filia Social Inclusion Measure (F-SIM) discriminated between n = 152 young adults aged 18-25 from the general community (M = 21.36, SD = 2.16) and n = 159 young adults aged 18-25 with SMI (M = 21.13, SD = 2.21).

RESULTS

Group membership was accounted for by Interpersonal Connections (Nagelkerke R² = .32), Vocational & Financial Security (Nagelkerke R² = .32) and Healthy Independent Lifestyle (Nagelkerke R² = .08) dimensions of the F-SIM. Relative to young adults from the general community, those with SMI were five times less likely to feel they had friends who would call on them in a crisis, odds ratio (OR) = .19 (95%CI = .04, .53), p = .04, almost five times more likely to live with their parents, OR = 4.79 (95%CI = 1.98,11.15), p = .004, almost four times less likely to have worked/studied any time over the past 12 months, OR = .27 (95%CI = .11,.64), p < .001, and three-and-a-half times more likely to report unstable accommodation, OR = 3.58 (95%CI = 1.14, 11.15), p = .03.

CONCLUSION

Young adults with SMI are socially excluded relative to peers from the general community in terms of interpersonal connections, vocational engagement, autonomy/independence and housing stability. In addition to the well-established focus on vocational engagement, interventions to improve social inclusion in this population must promote reciprocity within social relationships and healthy autonomy/independence (including stable housing).

Developing and testing the F-SIM, a measure of social inclusion for people with mental illness

Social inclusion is an important contributor to good mental health and greater mental health outcomes for people with psychiatric disorders. A psychometrically-sound measure of social inclusion is required to facilitate progress in this area. The aim here was to report on preliminary findings from a novel, user-friendly measure of social inclusion that comprehensively assesses the construct. Preliminary testing of the Filia Social Inclusion Measure (F-SIM) was conducted with ninety participants (30 consumers; 30 family members/carers; 30 community members). Participants completed the self-report measure and a usability questionnaire. Preliminary findings demonstrated poorer social inclusion for people with mental illness compared to those without, with differences seen in each of five domains (housing and services, social functioning, occupational functioning, finances and health). Differences were also seen regarding family members or carers, with consistently poorer social inclusion than general community members observed. Participants reported the F-SIM as easy to use, and considered it to measure social inclusion well, indicating good face validity. The F-SIM demonstrates an ability to differentiate between groups. Implications for use and suggestions for future research are detailed. Following further psychometric assessment, the F-SIM will have wide applicability in clinical and research settings.

Social inclusion and exclusion of people with mental illness in Timor-Leste: a qualitative investigation with multiple stakeholders

BACKGROUND

Social inclusion is a human right for all people, including people with mental illness. It is also an important part of recovery from mental illness. In Timor-Leste, no research has investigated the social experiences of people with mental illness and their families. To fill this knowledge gap and inform ongoing mental health system strengthening, we investigated the experiences of social inclusion and exclusion of people with mental illness and their families in Timor-Leste.

METHODS

Eighty-five participants from the following stakeholder groups across multiple locations in Timor-Leste were interviewed: (1) people with mental illness and their families; (2) mental health and social service providers; (3) government decision makers; (4) civil society members; and (5) other community members. Framework analysis was used to analyse interview transcripts.

RESULTS

People with mental illness in Timor-Leste were found to face widespread, multi-faceted sociocultural, economic and political exclusion. People with mental illness were stigmatised as a consequence of beliefs that they were dangerous and lacked capacity, and experienced instances of bullying, physical and sexual violence, and confinement. Several barriers to formal employment, educational, social protection and legal systems were identified. Experiences of social inclusion for people with mental illness were also described at family and community levels. People with mental illness were included through family and community structures that promoted unity and acceptance. They also had opportunities to participate in activities surrounding family life and livelihoods that contributed to intergenerational well-being. Some, but not all, Timorese people with mental illness benefited from disability-inclusive programming and policies, including the disability pension, training programs and peer support.

CONCLUSIONS

These findings highlight the need to combat social exclusion of people with mental illness and their families by harnessing local Timorese sociocultural strengths. Such an approach could centre around people with mental illness and their families to: increase population mental health awareness; bolster rights-based and culturally-grounded mental health services; and promote inclusive and accessible services and systems across sectors.

Motivational and cognitive correlates of community integration in homeless veterans entering a permanent supported housing program

Homelessness is a major public health problem, and serious mental illness (SMI) is highly prevalent in the homeless population. Although supported housing services-which provide permanent housing in the community along with case management-improve housing outcomes, community integration typically remains poor, and little is known about the underlying determinants of poor community integration postresidential placement. The general SMI literature has indicated that motivational and cognitive ability factors are key determinants of successful community integration, which provides a foundation for examining this issue. This study evaluated whether interview- and performance-based assessments of motivation, nonsocial and social-cognitive ability, and psychiatric symptoms were associated with community integration indices in 2 samples of homeless veterans either with (N = 96) or without (N = 80) a psychotic disorder who had recently been admitted to a supported housing program but who had not yet attained housing. Motivation indices, including experiential negative symptoms and defeatist performance attitudes, stood out as the most robust correlates (rs = -.30 to -.69) of community integration across both samples, particularly for social role participation. Demographics, general psychiatric symptoms, and nonsocial cognition showed generally weak relations with community integration, though social cognition showed a few relations. The consistent findings across samples point to the importance of motivational factors for understanding the determinants of poor community integration in this complex population. Further, interventions that target motivational challenges may have widespread usefulness for enhancing community integration outcomes beyond obtaining housing. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Overview of reviews of standardised occupation-based instruments for use in occupational therapy practice

INTRODUCTION

Using standardised instruments is one approach to support evidence-based practice. Referring to systematic reviews is an option to identify suitable instruments. However, with an abundance of systematic reviews available, therapists are challenged to identify an appropriate instrument to use. Therefore, this overview of reviews aimed to summarise relevant systematic review findings about standardised occupation-based instruments relevant for occupational therapy practice.

METHODS

An overview of reviews was conducted. A systematic search was performed on four databases up to March 2018. Included systematic reviews were analysed for quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR).

RESULTS

A total of 2187 articles were identified after removing duplicates. Ultimately, 58 systematic reviews were identified that yielded 641 instruments. From those, 45 instruments were selected for appraisal as they met the inclusion criteria of being developed mainly by occupational therapists and were recommended in the summarised findings from the systematic reviews. The instruments were classified according to the following occupation domains: (i) multidimensional, (ii) activities of daily living, (iii) productivity, (iv) social, (v) sleep/rest, (vi) sexuality and (vii) spirituality. No systematic review was identified that specifically focussed on occupations related to school/education, leisure and play.

DISCUSSION

Certain occupation domains such as activities of daily living, social and sleep/rest received high attention amongst researchers. There is a need for systematic reviews of instruments to measure education/school, play and leisure. Limited numbers of instruments were developed by occupational therapists outside the occupation domain of activities of daily living, and in areas of practice other than children and older people. Nevertheless, this overview can give some guidance for occupational therapists in selecting a suitable occupational therapy instrument for practice.

The social inclusion of young people with serious mental illness: A narrative review of the literature and suggested future directions

BACKGROUND

Social inclusion involves objective participatory (e.g. education/employment) and subjective (e.g. sense of belonging/acceptance) elements across multiple domains. It has been associated with enhanced physical and mental wellbeing yet is a novel construct in the empirical literature (i.e. measures have not been sufficiently developed).

AIMS

Young people with serious mental illness are reported to be socially excluded. It is unclear whether this is reflected in the social inclusion/exclusion literature. The aim of this narrative review is to determine whether such literature permits a comprehensive (i.e. multi-dimensional, objective and subjective) understanding of social inclusion among young people with serious mental illness.

METHODS

Searches to identify studies related to the social inclusion and/or exclusion of young people with serious mental illness were conducted on 16 February 2016, 24 August 2016, 16 February 2017, 24 August 2017 and 16 February 2018 in PsycINFO, MEDLINE, the Cochrane Library, SCOPUS, Open Grey, Web of Science, Google and Google Scholar.

RESULTS

There is a paucity of research in the explicit social inclusion literature involving young people either with or without serious mental illness as participants. Literatures exist in related independent areas of research (e.g. employment, social networks), but such studies employ heterogeneous methodologies.

CONCLUSION

Multi-dimensional measures of social inclusion incorporating objective and subjective indicators must be developed for young people with and without serious mental illness. This will enable the generation of normative and clinical data. Existing evidence for the social exclusion of young people with serious mental illness comes from objective indicators in isolated domains (e.g. unemployment). Subjective indicators continue to be under-researched. The above-described measures must be employed to further understanding of the apparent discrepancies between young people with serious mental illness and those without serious mental illness. This will elucidate the relationships between objective and subjective elements of social inclusion and the relationships between these elements and the psychological distress that young people with serious mental illness often experience. This has implications for intervention.

Re-imagining occupational wellbeing: Development of an evidence-based framework

BACKGROUND/AIM

Occupational therapists concern themselves with understanding engagement in everyday activity as a mode of facilitating wellbeing. However, there appears to be little consensus within the literature as to how engagement in meaningful activities contributes to wellbeing. Currently, there are no published evidence-based frameworks for wellbeing to support occupational therapy practitioners to address wellbeing with clients. The purpose of the study was to establish an evidence-based contemporary framework, domains and descriptive statements defining occupational wellbeing.

METHODS

A multiphase, exploratory sequential mixed methods design, using both qualitative and quantitative approaches was used. Two phases were identified for data collection. The first phase involved exploration of the domains of occupational wellbeing, through conducting a literature review and two focus groups. The Delphi technique was employed in the second phase to refine and corroborate the domains of occupational wellbeing with an expert panel.

RESULTS

Six new domains of occupational wellbeing were generated in the first phase of the study, namely: Competence, autonomy, contentment and pleasure, identity, hope and belonging. In the second phase, five out of the six domains reached a consensus level of 70% or more. Hope was the only domain not to reach consensus.

CONCLUSION

The framework for occupational wellbeing produced by this study was created using evidence-based, replicable methodology and garnered support from a highly regarded expert key informant group of occupational therapy and occupational science academics. Further exploration to determine whether there is widespread support and applicability for these domains with normative and vulnerable population groups is required.

Evaluating the psychometric quality of school connectedness measures: A systematic review

INTRODUCTION

There is a need to comprehensively examine and evaluate the quality of the psychometric properties of school connectedness measures to inform school based assessment and intervention planning.

OBJECTIVE

To systematically review the literature on the psychometric properties of self-report measures of school connectedness for students aged six to 14 years.

METHODS

A systematic search of five electronic databases and gray literature was conducted. The COnsensus-based Standards for the selection of heath Measurement INstruments (COSMIN) taxonomy of measurement properties was used to evaluate the quality of studies and a pre-set psychometric criterion was used to evaluate the overall quality of psychometric properties.

RESULTS

The measures with the strongest psychometric properties was the School Climate Measure and the 35-item version Student Engagement Instrument exploring eight and 12 (of 15) school connectedness components respectively.

CONCLUSIONS

The overall quality of psychometric properties was limited suggesting school connectedness measures available require further development and evaluation.