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Results for 'evidence-based practice'

Results 1 - 10 of 25

New horizons in supporting older people's health and wellbeing: is social prescribing a way forward?

HAMILTON-WEST Kate, MILNE Alisoun, HOTHAM Sarah
2020

Older people’s health and care needs are changing. Increasing numbers live with the combined effects of age-related chronic illness or disability, social isolation and/or poor mental health. Social prescribing has potential to benefit older people by helping those with social, emotional or practical needs to access relevant services and resources within the local community. However, researchers have highlighted limitations with the existing evidence-base, while clinicians express concerns about the quality of onward referral services, liability and upfront investment required. The current article provides a critical review of evidence on social prescribing, drawing on the RE-AIM Framework (Glasgow et al., 1999) to identify questions that will need to be addressed in order to inform both the design and delivery of services and the evolving research agenda around social prescribing. The authors emphasise the need for researchers and planners to work together to develop a more robust evidence-base, advancing understanding of the impacts of social prescribing (on individuals, services and communities), factors associated with variation in outcomes and strategies needed to implement effective and sustainable programmes. They also call on policymakers to recognise the need for investment in allied initiatives to address barriers to engagement in social prescribing programmes, provide targeted support for carers and improve access to older adult mental health services. The article concludes that social prescribing has potential to support older people’s health and wellbeing, but this potential will only be realised through strategic alignment of research, local level implementation and national policy and investment.

Evolving an evidence‐based model for homelessness prevention

OUDSHOORN Abe, et al
2020

While some progress has been made in addressing chronic homelessness through supportive models, a comprehensive solution for housing loss must include prevention. The purpose of this article is twofold: to conduct a review of the literature on the domains of the Framework for Homelessness Prevention; and to use literature on the concept of quaternary prevention, preventing the harms of service provision, to theorise an additional domain. The Framework for Homelessness Prevention draws upon theory from public health exploring primary, secondary and tertiary prevention, and also integrates primordial prevention. This leads to a typology of homelessness prevention that incorporates the following five domains: (a) Structural prevention; (b) Systems prevention; (c) Early intervention; (d) Eviction prevention; and (e) Housing stability. By systematically reviewing the literature we build out the evidence‐base supporting these domains. The team used research databases, internet searches and retrospective reference list reviews to identify high‐quality journal articles on prevention, which were then sorted by level of prevention. Through this process, we evolved our thinking on the Framework in considering that quaternary prevention was not initially included. Therefore, we explored the literature related to quaternary prevention in the context of homelessness and offer a sixth domain for the Framework: Empowerment. Ultimately, a comprehensive Framework for Homelessness Prevention will support communities and governments to more effectively prevent homelessness through upstream approaches.

Nostalgia as a psychological resource for people with dementia: a systematic review and meta-analysis of evidence of effectiveness from experimental studies

ISMAIL Sanda Umar, et al
2020

Objective: This review systematically examines evidence relating to the effect of nostalgia on psychological well-being through a meta-analysis of measures of social connectedness, self-esteem, meaning in life, self-continuity, optimism and positive and negative affect. Rationale: If nostalgia is to be used as a clinical intervention to boost well-being in dementia by reducing threat, then it is important to assess its therapeutic potential. Results: Searches carried out in July 2014 and updated in February 2018 identified 47 eligible experimental studies comparing nostalgic reminiscence and non-nostalgic reminiscence to be included in the meta-analysis. Nostalgic reminiscence had moderate effects on positive affect (0.51 (0.37, 0.65), p= 0.001), social connectedness (0.72 (0.57, 0.87), p= 0.001), self-esteem (0.50 (0.30, 0.70), p= 0.001), meaning in life (0.77 (0.47, 1.08), p= 0.001) and optimism (0.38 (0.28, 0.47), p= 0.001) and a large effect on self-continuity (0.81 (0.55, 1.07), p= 0.001). There was, however, no difference between the effect of nostalgic reminiscence and non-nostalgic reminiscence for negative affect (−0.06 (−0.20, 0.09), p= 0.443). Conclusion: This systematic review and meta-analysis provides an overview of the evidence base for nostalgia. This is an important stage in developing nostalgia as a clinical intervention for people with dementia which might be achieved, for instance, by adapting current reminiscence and life review techniques. This meta-analysis will therefore also serve as a valuable reference point for the continued exploration of nostalgia as an intervention.

Wellbeing evidence at the heart of policy

HARDOON Deborah, HEY Nancy, BRUNETTI Silvia
2020

Improving wellbeing is widely recognised as a goal of policy and practice. This report sets out the state of the evidence and next steps for applying a wellbeing approach to decision making in the UK. It looks at what is meant by wellbeing and how it is currently measured in the UK and Internationally. It considers how wellbeing can be improved, including a review evidence of what works and tools those working in a policy context need to implement these findings. It also considers the challenges of implementing a wellbeing approach and the role businesses, communities and individuals can play. The final section outlines some of the issues which have yet to be tackled in order for wellbeing to become the dominant narrative which underpins the decisions taken.

What approaches to social prescribing work, for whom, and in what circumstances? A realist review

HUSK Kerryn, et al
2020

The use of non‐medical referral, community referral or social prescribing interventions has been proposed as a cost‐effective alternative to help those with long‐term conditions manage their illness and improve health and well‐being. However, the evidence base for social prescribing currently lags considerably behind practice. In this paper, we explore what is known about whether different methods of social prescribing referral and supported uptake do (or do not) work. Supported by an Expert Advisory Group, we conducted a realist review in two phases. The first identified evidence specifically relating to social prescribing in order to develop programme theories in the form of ‘if‐then’ statements, articulating how social prescribing models are expected to work. In the second phase, we aimed to clarify these processes and include broader evidence to better explain the proposed mechanisms. The first phase resulted in 109 studies contributing to the synthesis, and the second phase 34. We generated 40 statements relating to organising principles of how the referral takes place (Enrolment), is accepted (Engagement), and completing an activity (Adherence). Six of these statements were prioritised using web‐based nominal group technique by our Expert Group. Studies indicate that patients are more likely to enrol if they believe the social prescription will be of benefit, the referral is presented in an acceptable way that matches their needs and expectations, and concerns elicited and addressed appropriately by the referrer. Patients are more likely to engage if the activity is both accessible and transit to the first session supported. Adherence to activity programmes can be impacted through having an activity leader who is skilled and knowledgeable or through changes in the patient's conditions or symptoms. However, the evidence base is not sufficiently developed methodologically for us to make any general inferences about effectiveness of particular models or approaches.

The effectiveness of interventions for reducing subjective and objective social isolation among people with mental health problems: a systematic review

MA Ruimin, et al
2019

Purpose: Subjective and objective social isolation are important factors contributing to both physical and mental health problems, including premature mortality and depression. This systematic review evaluated the current evidence for the effectiveness of interventions to improve subjective and/or objective social isolation for people with mental health problems. Primary outcomes of interest included loneliness, perceived social support, and objective social isolation. Methods: Three databases were searched for relevant randomised controlled trials (RCTs). Studies were included if they evaluated interventions for people with mental health problems and had objective and/or subjective social isolation (including loneliness) as their primary outcome, or as one of a number of outcomes with none identified as primary. Results: In total, 30 RCTs met the review’s inclusion criteria: 15 included subjective social isolation as an outcome and 11 included objective social isolation. The remaining four evaluated both outcomes. There was considerable variability between trials in types of intervention and participants’ characteristics. Significant results were reported in a minority of trials, but methodological limitations, such as small sample size, restricted conclusions from many studies. Conclusion: The evidence is not yet strong enough to make specific recommendations for practice. Preliminary evidence suggests that promising interventions may include cognitive modification for subjective social isolation, and interventions with mixed strategies and supported socialisation for objective social isolation. This study highlights the need for more thorough, theory-driven intervention development and for well-designed and adequately powered RCTs.

Evaluating social care prevention in England: challenges and opportunities

MARCZAK Joanna, WISTOW Gerald, FERNANDEZ Jose-Luis
2019

Context: The Care Act 2014 placed a statutory duty on adult social care (ASC) to prevent and delay the development of needs for care and support. There is little clarity about how to translate this national obligation into effective local practice. Objectives: This exploratory study sought to lay the foundations for understanding approaches to this new duty by identifying: emerging local understandings of prevention; associated implementation strate­gies; and the potential for designing evaluation frameworks. Methods: Local perspectives were secured through: in-depth interviews in six English local authorities; reviews of local strategy, implementation documents and reviews of data sources; and methods for evaluating local initiatives in sampled authorities. Findings: The findings indicate important differences between and within local authorities in conceptuali­sations of prevention. Although willingness to commission services was strongly linked to the availability of evidence on what works in prevention, council conducted limited local evaluations. This study also found limited collaboration between ASC and Health in developing joint prevention approaches, in part due to differ­ences in conceptualisation and also constraints arising from different priorities and information systems. Limitations: The exploratory nature of the study and the small sample size limits the generalisability of its findings. Overall, the number of local authorities and respondents allowed us to explore a range of local views, opinions and practices related to the prevention agenda in a variety of contexts, however the findings are not generalisable to all English local authorities. Implications: This study suggests that the limited local evidence about prevention, combined with finan­cial austerity, may lead to disproportionate investment in a small number of interventions where existing evidence suggests cost-savings potential, which, in turn, may impact authorities’ ability to fulfil their statutory duties related to preventing and delaying the needs for care and support. In this connection, this study highlights the potential for developing local evaluation strategies utilising existing but largely unexploited local administrative data collections.

The impact of social prescribing services on service users: a systematic review of the evidence

PESCHENY Julia Vera, RANDHAWA Gurch, PAPPAS Yannis
2019

Background: Social prescribing initiatives are widely implemented in the UK National Health Service to integrate health and social care. Social prescribing is a service in primary care that links patients with non-medical needs to sources of support provided by the community and voluntary sector to help improve their health and wellbeing. Such programmes usually include navigators, who work with referred patients and issue onward referrals to sources of non-medical support. This systematic review aimed to assess the evidence of service user outcomes of social prescribing programmes based on primary care and involving navigators. Methods: 11 databases, the grey literature, and the reference lists of relevant studies were searched to identify the available evidence on the impact of social prescribing on service users. Searches were limited to literature written in English. No date restrictions were applied, and searches were conducted to June 2018. Findings were synthesised narratively, employing thematic analysis. The Mixed Methods Appraisal Tool Version 2011 was used to evaluate the methodological quality of included studies. Results: Sixteen studies met the inclusion criteria. The evidence base is mixed, some studies found improvements in health and wellbeing, health-related behaviours, self-concepts, feelings, social contacts and day-to-day functioning post-social prescribing, whereas others have not. The review also shows that the evaluation methodologies utilised were variable in quality. Conclusion: In order to assess the success of social prescribing services, more high quality and comparable evaluations need to be conducted in the future.

Public mental health: evidence, practice and commissioning

CAMPION Jonathan
2019

Based on a review of recent literature, this report summarises evidence around public mental health practice. Public mental health practice takes a population approach to mental health which includes three levels of mental disorder prevention and mental wellbeing promotion. The review covers: the impact of mental health problems and of mental wellbeing; risk factors for mental disorder and protective factors for mental wellbeing; groups at higher risk of poor mental health; effective interventions to treat mental disorder and to prevent associated impacts, preventing mental disorder from arising and promoting mental wellbeing; and economic savings of different public mental health interventions. It finds that despite the existence of cost-effective public mental health interventions, only a minority of people with a mental condition in England receive any treatment, receive interventions to prevent associated impacts or receive intervention to prevent mental conditions or promote mental wellbeing. It sets out a number of actions to improve coverage of evidence based interventions to reduce the population impact of mental disorder and promote population mental wellbeing. The report has been endorsed by the Association of Directors of Public Health, Faculty of Public Health, Health Education England, Local Government Association, Royal College of General Practitioners, Royal College of Psychiatrists and RSPH (Royal Society of Public Health).

Preventive social care: is it cost effective?

CURRY Natasha
2006

This paper attempts to pull together and review key pieces of evidence about the cost effectiveness of prevention. The findings, which reflect a paucity of quantified information about the effectiveness of preventive interventions, suggest that there is a strong financial case for reducing hospitalisation (particularly through falls) and for reducing the rate of institutionalisation by maintaining independence. Small-scale trials show that small interventions could prevent falls and reduce the rate of institutionalisation. However, establishing a direct causal relationship between such interventions and long-term financial savings has proved problematic although. There is a lack of consensus over the cost effectiveness of intermediate care although there is evidence that it is cost effective when targeting specific groups/illnesses/events such as stroke and falls. Evidence for secondary stroke prevention services is perhaps the strongest, and most widely quantified, body of research. There is some evidence that primary prevention strategies (such as smoking cessation and reduced salt intake) have potential to reduce the incidence of stroke. The paper makes a series of recommendations, calling for a greater focus on low-level interventions, particularly where there is qualitative evidence that they are valued by service users; implementation of promising interventions, even if not supported by robust evidence, accompanying by formal evaluation during roll-out; development of standard outcome measures of prevention; targeting resources to ensure greatest impact; and greater integration between health and social care services as a drive to shift services towards the preventive end of the spectrum.

Results 1 - 10 of 25

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