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Results for 'evidence'

Results 1 - 10 of 26

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.

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.

Evidence on the contribution of community gardens to promote physical and mental health and well-being of non-institutionalized individuals: a systematic review

LAMPERT Tarsila, et al
2021

Objectives: To synthetize the literature about physical and mental health outcomes associated with community gardening. Two main questions were addressed: a) is there evidence, from quantitative studies, that community gardening is associated to physical and mental health and well-being of non-institutionalized individuals? b) Does community gardening provokes any discomfort in terms of physical health, i.e., bodily pain, to their beneficiaries? Methods: A systematic review of the literature was carried out following PRISMA guidelines by searching relevant electronic databases (PubMed, Scopus, and Web of Science). Empirical, quantitative studies published in English with no restrictions concerning the date of publication were considered eligible. The quality of the evidence was appraised using the tool developed by the National Heart, Lung, and Blood Institute of the National Institutes of Health for Observational Cohort and Cross-Sectional Studies. Results: Overall, 8 studies were considered eligible, of which seven studies were rated as having good methodological quality (one scored as fair). Community gardeners had significantly better health outcomes than their neighbours not engaged in gardening activities in terms of life satisfaction, happiness, general health, mental health, and social cohesion. Conclusion: Community gardens are associated to health gains for their users, irrespective of age, being an affordable and efficient way of promoting physical and mental health and well-being. To encourage the design, maintenance, and prospective evaluation of supportive urban environments promoting healthy and, at the same time, sustainable lifestyles, is essential to achieve public health gains and environmental sustainability.

Efficacy of exercise-based interventions in preventing falls among community-dwelling older persons with cognitive impairment: is there enough evidence? An updated systematic review and meta-analysis

LI Fuzhong, et al
2021

Objective: Exercise prevents falls in the general older population, but evidence is inconclusive for older adults living with cognitive impairment. This study is an updated systematic review and meta-analysis to assess the potential effectiveness of interventions for reducing falls in older persons with cognitive impairment. Methods: PubMed, EMBASE, CINAHL, Scopus, CENTRAL and PEDro were searched from inception to 10 November 2020. This study included randomised controlled trials (RCTs) that evaluated the effects of physical training compared to a control condition (usual care, waitlist, education, placebo control) on reducing falls among community-dwelling older adults with cognitive impairment (i.e. any stage of Alzheimer’s disease and related dementias, mild cognitive impairment). Results: This study identified and meta-analysed nine studies, published between 2013 and 2020, that included 12 comparisons (N = 1,411; mean age = 78 years; 56% women). Overall, in comparison to control, interventions produced a statistically significant reduction of approximately 30% in the rate of falls (incidence rate ratio = 0.70; 95% CI, 0.52-0.95). There was significant between-trial heterogeneity (I2 = 74%), with most trials (n = 6 studies [eight comparisons]) showing no reductions on fall rates. Subgroup analyses showed no differences in the fall rates by trial-level characteristics. Exercise-based interventions had no impact on reducing the number of fallers (relative risk = 1.01; 95% CI, 0.90–1.14). Concerns about risk of bias in these RCTs were noted, and the quality of evidence was rated as low. Conclusions: The positive statistical findings on reducing fall rate in this meta-analysis were driven by a few studies. Therefore, current evidence is insufficient to inform evidence-based recommendations or treatment decisions for clinical practice.

Can social prescribing foster individual and community well-being? A systematic review of the evidence

VIDOVIC Dragana, REINHARDT Gina Yannitell, HAMMERTON Clare
2021

Social prescribing programmes (SP) are person-centred coaching schemes meant to help participants improve individual circumstances, thereby to reduce demand on health and social care. SP could be an innovative means to improve preventive and public health in the pursuit of universal financially sustainable healthcare. Given its potential, our systematic review assesses type, content, and quality of evidence available regarding SP effectiveness at the individual, system, and community levels. This study examine the impact of SP on addressing loneliness, social isolation, well-being, and connectedness, as well as related concepts, which are not yet considered jointly in one study. Following PRISMA, search: EBSCOHost (CINAHL Complete; eBook Collection; E-Journals; MEDLINE Full Text; Open Dissertations; PsycARTICLES; PsycINFO); Web of Science Core Collection; and UK National Institute for Health and Care Excellence. Excluding systematic reviews and articles without impact evaluations, this study reviewed 51 studies. Several studies do not distinguish between core concepts and/or provide information on the measures used to assess outcomes; exactly one peer-reviewed study presents a randomised controlled trial. If we wish to know the potential of social prescribing to lead to universal financially sustainable healthcare, we urge researchers and practitioners to standardise definitions and metrics, and to explore conceptual linkages between social prescribing and system/community outcomes

A systematic review to examine the evidence in developing social prescribing interventions that apply a co-productive, co-designed approach to improve well-being outcomes in a community setting

THOMAS Gwenlli, LYNCH Mary, SPENCER Llinos Haf
2021

This systematic review aims to investigate the evidence in applying a co-design, co-productive approach to develop social prescribing interventions. A growing body of evidence suggests that co-production and co-design are methods that can be applied to engage service users as knowledgeable assets who can contribute to developing sustainable health services. Applying the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search was conducted. Peer-reviewed articles were sought using electronic databases, experts and grey literature. The review search concluded with eight observational studies. Quality appraisal methods were influenced by the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Framework approach. A narrative thematic synthesis of the results was conducted. The evidence suggests that a co-design and co-productive social prescribing can lead to positive well-being outcomes among communities. Barriers and facilitators of co-production and co-design approach were also highlighted within the evidence. The evidence within this review confirms that a co-production and co-design would be an effective approach to engage stakeholders in the development and implementation of a SP intervention within a community setting. The evidence also implies that SP initiatives can be enhanced from the outset, by drawing on stakeholder knowledge to design a service that improves health and well-being outcomes for community members.

Intergenerational programmes bringing together community dwelling non-familial older adults and children: a systematic review

PETERS Ruth, et al
2021

Background: Social isolation is associated with an increased risk of adverse health outcomes, including functional decline, cognitive decline, and dementia. Intergenerational engagement, i.e. structured or semi structured interactions between non-familial older adults and younger generations is emerging as tool to reduce social isolation in older adults and to benefit children and adults alike. This has great potential for our communities, however, the strength and breadth of the evidence for this is unclear. The researchers undertook a systematic review to summarise the existing evidence for intergenerational interventions with community dwelling non-familial older adults and children, to identify the gaps and to make recommendations for the next steps. Methods: Medline, Embase and PsychInfo were searched from inception to the 28th Sept 2020. Articles were included if they reported research studies evaluating the use of non-familial intergenerational interaction in community dwelling older adults. PROSPERO registration number CRD42020175927 Results: Twenty articles reporting on 16 studies were included. Although all studies reported positive effects in general, numerical outcomes were not recorded in some cases, and outcomes and assessment tools varied and were administered un-blinded. Caution is needed when making interpretations about the efficacy of intergenerational programmes for improving social, health and cognitive outcomes. Discussion: Overall, there is neither strong evidence for nor against community based intergenerational interventions. The increase in popularity of intergenerational programmes alongside the strong perception of potential benefit underscores the urgent need for evidence-based research.

Interventions for reducing loneliness: an umbrella review of intervention studies

VERONESE Nicola, et al
2020

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. The researchers 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.

Strengths, assets and place - the emergence of Local Area Coordination initiatives in England and Wales

LUNT Neil, BAINBRIDGE Laura, RIPPON Simon
2021

Summary: Local Area Coordination is an approach that emerged during the 1980s and 1990s to support individuals with learning disabilities in rural and metropolitan Western Australia. Offering direct family support, signposting and networking it aimed to improve access to services and promote social inclusion. It leveraged community resources and sought broader transformation through local collaborations and service redesign, as underpinned by a strengths-based philosophy. Scotland introduced a similar model of delivery from the early 2000s for learning disability support. Since 2010, a number of English and Welsh Local Authorities have introduced Local Area Coordination, and in doing so have expanded its support eligibility criteria to include those considered ‘vulnerable’ due to age, frailty, disability, mental health issues and housing precariousness. Findings: This article provides the first review of developments in England and Wales. Drawing upon published evaluation studies it reflects on Local Area Coordination implementation; reviews the existing evidence base and challenges surrounding data collection; and discusses the competing logic of Local Area Coordination in its aim of supporting individual and community improvement of health outcomes and well-being, and of furthering local government civic engagement and participation. Applications: This article points to the challenges and opportunities of implementing such a strength-, assets- and placed-based initiatives within Local Authority social service settings. Embedding Local Area Coordination within Local Authority settings requires skilled political and policy leadership. It balances emerging individual outcomes – health and well-being – with the civic mission (values, control and coproduction), and avoids one being subverted to the other.

Community exchange and time currencies: a systematic and in-depth thematic review of impact on public health outcomes

LEE C, et al
2020

Objectives: Austerity in government funding, and public service reform, has heightened expectations on UK communities to develop activities and resources supportive of population health and become part of a transformed place-based system of community health and social care. As non-monetary place-based approaches, Community Exchange/Time Currencies could improve social contact and cohesion, and help mobilise families, neighbourhoods, communities and their assets in beneficial ways for health. Despite this interest, the evidence base for health outcomes resulting from such initiatives is underdeveloped. Study design: A systematic review. Methods: A literature review was conducted to identify evidence gaps and advance understanding of the potential of Community Exchange System. Studies were quality assessed, and evidence was synthesised on ‘typology’, population targeted and health-related and wider community outcomes. Results: The overall study quality was low, with few using objective measures of impact on health or well-being, and none reporting costs. Many drew on qualitative accounts of impact on health, well-being and broader community outcomes. Although many studies lacked methodological rigour, there was consistent evidence of positive impacts on key indicators of health and social capital, and the data have potential to inform theory. Conclusions: Methodologies for capturing impacts are often insufficiently robust to inform policy requirements and economic assessment, and there remains a need for objective, systematic evaluation of Community Exchange and Time Currency systems. There is also a strong argument for deeper investigation of ‘programme theories’ underpinning these activities, to better understand what needs to be in place to trigger their potential for generating positive health and well-being outcomes.

Results 1 - 10 of 26

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