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Reducing loneliness among migrant and ethnic minority people: a participatory evidence synthesis

SALWAY Sarah, et al
2020

Background: To date, there has been little research into the causes of, and solutions to, loneliness among migrant and ethnic minority people. Objectives: The objectives were to synthesise available evidence and produce new insights relating to initiatives that aim to address loneliness among these populations, plus the logic, functioning and effects of such initiatives. Data sources: Electronic database searches (MEDLINE, Applied Social Sciences Index and Abstracts and Social Science Citation Index via Web of Science – no date restrictions were applied), grey literature searches, and citation and reference searching were conducted. Data were generated via nine workshops with three consultation panels involving 34 public contributors, and one practitioner workshop involving 50 participants. Review methods: Guided by ‘systems thinking’, a theory-driven synthesis was combined with an effectiveness review to integrate evidence on the nature and causes of loneliness, interventional types and programme theory, and intervention implementation and effectiveness. Results: The theory review indicated that common conceptualisations of ‘loneliness’ can be usefully extended to recognise four proximate determinants when focusing on migrant and ethnic minority populations: positive social ties and interactions, negative social ties and interactions, self-worth, and appraisal of existing ties. A total of 170 interventions were included. A typology of eight interventions was developed. Detailed logic models were developed for three common types of intervention: befriending, shared-identity social support groups and intercultural encounters. The models for the first two types were generally well supported by empirical data; the third was more tentative. Evaluation of intervention processes and outcomes was limited by study content and quality. Evidence from 19 qualitative and six quantitative studies suggested that social support groups have a positive impact on dimensions of loneliness for participants. Evidence from nine qualitative and three quantitative studies suggested that befriending can have positive impacts on loneliness. However, inconsistent achievements of the befriending model meant that some initiatives were ineffective. Few studies on intercultural encounters reported relevant outcomes, although four provided some qualitative evidence and three provided quantitative evidence of improvement. Looking across intervention types, evidence suggests that initiatives targeting the proximate determinants – particularly boosting self-worth – are more effective than those that do not. No evidence was available on the long-term effects of any initiatives. UK intervention (n = 41) and non-intervention (n = 65) studies, together with consultation panel workshop data, contributed to a narrative synthesis of system processes. Interlocking factors operating at individual, family, community, organisational and wider societal levels increase risk of loneliness, and undermine access to, and the impact of, interventions. Racism operates in various ways throughout the system to increase risk of loneliness. Limitations: There was a lack of high-quality quantitative studies, and there were no studies with longer-term follow-up. UK evidence was very limited. Studies addressing upstream determinants operating at the community and societal levels did not link through to individual outcome measures. Some elements of the search approach may mean that relevant literature was overlooked. Conclusions: Theory regarding the causes of loneliness, and functioning of interventions, among migrant and ethnic minority populations was usefully developed. Evidence of positive impact on loneliness was strongest for shared-identity social support groups. Quantitative evidence was inadequate. The UK evidence base was extremely limited. Future work: UK research in this area is desperately needed. Co-production of interventional approaches with migrant and ethnic minority people and evaluation of existing community-based initiatives are priorities.

Do home adaptation interventions help to reduce emergency fall admissions? A national longitudinal data-linkage study of 657,536 older adults living in Wales (UK) between 2010 and 2017

HOLLINGHURST Joe, et al
2021

Background: falls are common in older people, but evidence for the effectiveness of preventative home adaptations is limited. Aim: determine whether a national home adaptation service, Care&Repair Cymru (C&RC), identified individuals at risk of falls occurring at home and reduced the likelihood of falls. Study Design: retrospective longitudinal controlled non-randomised intervention cohort study. Setting: our cohort consisted of 657,536 individuals aged 60+ living in Wales (UK) between 1 January 2010 and 31 December 2017. About 123,729 individuals received a home adaptation service. Methods: we created a dataset with up to 41 quarterly observations per person. For each quarter, we observed if a fall occurred at home that resulted in either an emergency department or an emergency hospital admission. We analysed the data using multilevel logistic regression. Results: compared to the control group, C&RC clients had higher odds of falling, with an odds ratio (OR [95% confidence interval]) of 1.93 [1.87, 2.00]. Falls odds was higher for females (1.44 [1.42, 1.46]), older age (1.07 [1.07, 1.07]), increased frailty (mild 1.57 [1.55, 1.60], moderate 2.31 [2.26, 2.35], severe 3.05 [2.96, 3.13]), and deprivation (most deprived compared to least: 1.16 [1.13, 1.19]). Client fall odds decreased post-intervention; OR 0.97 [0.96, 0.97] per quarter. Regional variation existed for falls (5.8%), with most variation at the individual level (31.3%). Conclusions: C&RC identified people more likely to have an emergency fall admission occurring at home, and their service reduced the odds of falling post-intervention. Service provisioning should meet the needs of an individual and need varies by personal and regional circumstance.

The role of collaborative working between the arts and care sectors in successfully delivering participatory arts activities for older people in residential care settings

BUNGAY Hilary, et al
2021

In the UK support for older people living in residential care to undertake meaningful activities is provided by Activities Co-ordinators. There is also a growing trend for care home providers to invite arts organisations into care settings to deliver a range of arts and cultural activities. These arts and cultural activities are delivered by Arts Facilitators, who are distinct from Activities Co-ordinators because their practice is specifically in an art form. This paper presents findings from the Creative Journeys research project which focused on exploring the role of participatory arts within residential care home in developing and maintaining social relationships between residents and staff. One of the objectives of the research was to identify factors which facilitated or hindered the delivery and impact of the activities. Data collection methods included observations and semi-structured interviews with residents and staff. Thematic analysis was conducted on the qualitative data. It was found that a key factor in the successful delivery of the groups was the working relationship between the Arts Facilitators and the Activities Co-ordinators. This relationship is explored and presented under three main themes: the collaborative process, practicalities and preparation and the approach of the Arts Facilitator. The Activities Co-ordinators’ role is an under-researched area, but they play a central role in supporting visiting arts organisations to deliver the sessions and in enabling residents to attend and engage with meaningful activities.

Does arts engagement and cultural participation impact depression outcomes in adults: a narrative descriptive systematic review of observational studies

ELSDEN Esme, ROE Brenda
2021

Purpose: The purpose of this study is to explore whether engaging with arts and culture affect depression in adults. This is because depression is the most common mental health disorder. Diversification of mental health services, initiatives in arts in health and social prescribing are providing emerging evidence of benefits relating to depression outcomes. Design/methodology/approach: A systematic review design adhering to the preferred reporting items for systematic reviews and meta-analyses reporting guidelines. MEDLINE®, Embase and American psychology association PsycINFO were searched and six studies were deemed eligible. Data extraction and quality appraisal enabled a narrative descriptive summary comparing study design, characteristics, populations and key results relating arts and cultural engagement to depression outcomes. Findings: The total number of participants across the studies were 49,197. Three studies reported mean age, 58.78 years (15–99 years). Gender reported by five studies was 52.4% (n = 24,689) female and 47.6% (n = 22,439) male. Five studies found that engaging with arts decreased your odds of having depression. Originality/value: This systematic review found emerging evidence that arts and cultural engagement benefits a wider population by reducing depression incidence. Establishing and understanding the association between arts engagement and decreasing depression incidence in a population is relevant to health-care providers, the general population and policymakers alike.

Changing lives, changing systems: reconnecting lonely older people with their community

JONES Dan, SOCIAL FINANCE
2021

This report shares learning from practical experience of impact at scale. It focuses on Reconnections, a service which aims to address loneliness and social isolation among older people. Reconnections was transferred to Independent Age – a leading UK wide charity that supports older people and has the specialist skills and resources to replicate it. In the ‘Community Connector’ intervention, volunteers help lonely individuals to reconnect with groups and activities in their community, based on their personal interests and aspirations. The Reconnections experience suggests a number of lessons for organisations seeking to grow new approaches to social problems through this kind of ‘transfer approach’ to scale: 1. Invest in defining and evaluating a ‘product’ – another organisation will only take on your new model if you can define it specifically enough and demonstrate its feasibility and effectiveness 2. Codify the product – describing your model specifically enough for another organisation to pick it up and deliver it is a separate task in itself 3. Transfer people as well as product – sharing and embedding of tacit knowledge and culture 4. Find the right ‘parent’ – above all, ensure that the new organisation’s mission and ethos are well aligned with yours, as well as the resources and capabilities for delivery at scale 5. Allow for adaptation – even the best defined model will need modification to fit with the new organisation and new sites 6. Consider the context – it’s important to recognise that this approach is unusual in the voluntary sector, and you will need to consider if the context will support a successful transfer.

How can we reduce the toll of loneliness in older adults?

NATIONAL INSTITUTE FOR HEALTH RESEARCH
2021

This alert brings together key findings on loneliness in older adults, to build a picture of what is known, and what is needed, to address the problem. The briefing covers: What is loneliness? How loneliness takes a heavy toll on health; How to address loneliness in the community; How professionals can help people in the community; How families and friends can help; Addressing loneliness in care homes; and How care staff can help. Key messages: research suggests that almost one in three people over 75 – and almost two in three carers of people with dementia - are lonely; the need to see older people as individuals; just two minutes extra with each older patient could make interactions more meaningful. Research also points to difficulties in introducing change. It suggests that care home staff need ongoing support to bring in new programmes to engage elderly residents. Future research will also be needed to explore loneliness among diverse groups in the population. Conclusion: a concerted effort to reduce loneliness in older adults would bring long-term benefits to the physical health of the population. It would also make a difference immediately to those people and their carers.

Loneliness, older people and a proposed social work response

HAGAN Robert
2021

Summary: This article is based upon a scoping review of literature about older people and loneliness. Findings: Increasingly in the UK, older people’s experience of loneliness is conceptualised as a public health concern. Social workers will wish to respond appropriately to older adults reporting loneliness but may react on the basis of keenly held assumptions about loneliness in later life, with scant regard to distinct subcategorisation of the construct. Exploring what an appropriate social work response may be, this article first sets out four misconceptions related to older people’s loneliness: that older people are especially lonely, loneliness correlates with living alone, strengthening family networks is best for alleviating loneliness, and loneliness interventions should tackle the issue directly. Applications: A proposed model is introduced regarding social work intervention, focusing upon direct assessment of needs, the maintenance of meaningful existing relationships and, if required, potential introduction of new social support avenues. Additionally, it is recognised that a separate response to long-term chronic loneliness may involve psychological work addressing cognition.

Effectiveness and sustainability of volunteering with older people living in care homes: a mixed methods systematic review

HANDLEY Melanie, et al
2021

Older people living in care homes should be considered part of the wider local community; however, little is known about what enables them to connect with people not paid to look after them or family members. Volunteering can complement paid and familial support. While volunteering is common in community settings, care home residents are less likely to benefit from their input. We conducted a mixed methods systematic review and stakeholder consultation that aimed to identify volunteer activities in care homes and evidence for their effectiveness and sustainability. Databases were searched from 2000 to July 2021. Studies of all designs reporting volunteer-led activities with care home residents 65-years or over were included. Data on interventions, study population, study context, outcomes and implementation issues were extracted and synthesised. We identified 36 studies on the use, effectiveness and implementation of volunteering in care homes, although the overall strength of evidence was weak. Resident engagement and mood appeared to improve during volunteer-led activities, but there was little research examining the longer-term impact. Qualitative and stakeholder data suggest considerable investment is needed to initiate and maintain volunteering initiatives, but there are positive benefits for volunteers, residents and staff if an intervention is sustained. Financial cost for care home facilities is unclear. Interventions that address inequalities in accessing volunteer support within the resident population and between facilities should be considered.

Interventions for reducing loneliness: an umbrella review of intervention studies

VERONESE Nicola, et al
2021

Loneliness is a common phenomenon associated with several negative health outcomes. Current knowledge regarding interventions for reducing loneliness in randomised controlled trials (RCTs) is conflicting. The aim of the present work is to provide an overview of interventions to reduce loneliness, using an umbrella review of previously published systematic reviews and meta-analyses. We searched major databases from database inception to 31 March 2020 for RCTs comparing active versus non-active interventions for reducing loneliness. For each intervention, random-effects summary effect size and 95% confidence intervals (CIs) were calculated. For significant outcomes (p-value < 0.05), the GRADE (Grading of Recommendations Assessment, Development and Evaluation) tool was used, grading the evidence from very low to high. From 211 studies initially evaluated, seven meta-analyses for seven different types of interventions were included (median number of RCTs: 8; median number of participants: 600). Three interventions were statistically significant for reducing loneliness, that is, meditation/mindfulness, social cognitive training and social support. When applying GRADE criteria, meditation/mindfulness (mean difference, MD = −6.03; 95% CI: −9.33 to −2.73; very low strength of the evidence), social cognitive training (8 RCTs; SMD = −0.49; 95% CI: −0.84 to −0.13; very low strength of the evidence) and social support (9 RCTs; SMD = −0.13; 95% CI: −0.25 to −0.01; low strength of the evidence) significantly decreased the perception of loneliness. In conclusion, three intervention types may be utilised for reducing loneliness, but they are supported by a low/very low certainty of evidence indicating the need for future large-scale RCTs to further investigate the efficacy of interventions for reducing loneliness.

Impact of social prescribing to address loneliness: a mixed methods evaluation of a national social prescribing programme

FOSTER Alexis, et al
2021

Loneliness is considered a global public health issue because of its detrimental impact on physical and mental health but little is known about which interventions can reduce loneliness. One potential intervention is social prescribing, where a link worker helps service-users to access appropriate support such as community activities and social groups. Some qualitative studies have identified that social prescribing may help to reduce service-users’ loneliness. Given this, the British Red Cross (a third sector organisation) developed and delivered a national social prescribing service in the United Kingdom to support people who were experiencing, or at risk of, loneliness. Service-users could receive up to 12 weeks of support from a link worker. A mixed methods study was conducted to understand the impact of the support on loneliness, and to identify the facilitators and barriers to service delivery. The study included: (a) analysis of quantitative data collected routinely between May 2017 and December 2019 (n = 10,643) including pre-post analysis of UCLA data (n = 2,250) and matched comparator work to measure changes in loneliness; (b) semi-structured interviews with service-users, link workers and volunteers (n = 60) and (c) a Social Return on Investment Analysis. The majority of the service-users (72.6%, n = 1634/2250) felt less lonely after receiving support. The mean change in UCLA score was −1.84 (95% CI −1.91 to −1.77) of a maximum change of 6.00 (decrease indicates an improvement). Additional benefits included improved wellbeing, increased confidence and life having more purpose. The base case analysis estimated a social return on investment of £3.42 per £1 invested in the service. Having skilled link workers and support tailored to individual needs appeared key. However, challenges included utilising volunteers, meeting some service-users’ needs in relation to signposting and sustaining improvements in loneliness. Nonetheless, the service appeared successful in supporting service-users experiencing loneliness.

Results 1 - 10 of 790

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News

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LAUGH research project

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