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Results for 'evidence-based practice'

Results 1 - 10 of 12

Arts on prescription for community‐dwelling older people with a range of health and wellness needs

POULOS Roslyn G., et al
2019

Published evidence for the role of participatory art in supporting health and well‐being is growing. The Arts on Prescription model is one vehicle by which participatory art can be delivered. Much of the focus of Arts on Prescription has been on the provision of creative activities for people with mental health needs. This Arts on Prescription program, however, targeted community‐dwelling older people with a wide range of health and wellness needs. Older people were referred to the program by their healthcare practitioner. Professional artists led courses in visual arts, photography, dance and movement, drama, singing, or music. Classes were held weekly for 8–10 weeks, with six to eight participants per class, and culminated with a showing of work or a performance. Program evaluation involved pre‐ and postcourse questionnaires, and focus groups and individual interviews. Evaluation data on 127 participants aged 65 years and older were available for analysis. This study found that Arts on Prescription had a positive impact on participants. Quantitative findings revealed a statistically significant improvement in the Warwick–Edinburgh Mental Well‐being Scale (WEMWBS) as well as a statistically significant increase in the level of self‐reported creativity and frequency of creative activities. Qualitative findings indicated that the program provided challenging artistic activities which created a sense of purpose and direction, enabled personal growth and achievement, and empowered participants, in a setting which fostered the development of meaningful relationships with others. This evaluation adds to the evidence base in support of Arts on Prescription by expanding the application of the model to older people with a diverse range of health and wellness needs.

Raising the bar on strength and balance: the importance of community-based provision

CENTRE FOR AGEING BETTER
2019

This report draws on work from the University of Manchester Healthy Ageing Research Group, which worked with communities to better understand the challenges of delivering strength and balance programmes for older adults in the local community. These activities could include resistance training, aerobics classes and yoga groups. The report argues that NHS falls rehabilitation services often don’t have the funding or ability to provide sufficient strength and balance programmes to meet existing needs, which means an effective community-based response is essential. The report presents different models of delivery of community-based activities, barriers to delivery and examples of innovative solutions identified during the project. The findings cover five themes: raising awareness, encouraging uptake, exercise referral pathways that work, sticking to the evidence, and monitoring for outcomes and improvements. Each theme highlights five key points to ensure that strength and balance exercise programmes are delivered to the right people, at the right time, and by the right people, so that older adults achieve positive results. Recommendations for commissioners, providers and health care professionals are also included. These include for NHS and local authorities support evidence-based programmes and for improved collaboration between those referring people to programmes and those delivering them.

The (cost‐)effectiveness of preventive, integrated care for community‐dwelling frail older people: a systematic review

LOOMAN Wilhelmina Mijntje, HUIJSMAN Robbert, FABBRICOTTI Isabelle Natalina
2019

Integrated care is increasingly promoted as an effective and cost‐effective way to organise care for community‐dwelling frail older people with complex problems but the question remains whether high expectations are justified. Our study aims to systematically review the empirical evidence for the effectiveness and cost‐effectiveness of preventive, integrated care for community‐dwelling frail older people and close attention is paid to the elements and levels of integration of the interventions. We searched nine databases for eligible studies until May 2016 with a comparison group and reporting at least one outcome regarding effectiveness or cost‐effectiveness. We identified 2,998 unique records and, after exclusions, selected 46 studies on 29 interventions. We assessed the quality of the included studies with the Effective Practice and Organization of Care risk‐of‐bias tool. The interventions were described following Rainbow Model of Integrated Care framework by Valentijn. Our systematic review reveals that the majority of the reported outcomes in the studies on preventive, integrated care show no effects. In terms of health outcomes, effectiveness is demonstrated most often for seldom‐reported outcomes such as well‐being. Outcomes regarding informal caregivers and professionals are rarely considered and negligible. Most promising are the care process outcomes that did improve for preventive, integrated care interventions as compared to usual care. Healthcare utilisation was the most reported outcome but we found mixed results. Evidence for cost‐effectiveness is limited. High expectations should be tempered given this limited and fragmented evidence for the effectiveness and cost‐effectiveness of preventive, integrated care for frail older people. Future research should focus on unravelling the heterogeneity of frailty and on exploring what outcomes among frail older people may realistically be expected.

The arts as a medium for care and self-care in dementia: arguments and evidence

SCHNEIDER Justine
2018

The growing prevalence of dementia, combined with an absence of effective pharmacological treatments, highlights the potential of psychosocial interventions to alleviate the effects of dementia and enhance quality of life. With reference to a manifesto from the researcher network Interdem, this paper shows how arts activities correspond to its definition of psycho-social care. It presents key dimensions that help to define different arts activities in this context, and illustrates the arts with reference to three major approaches that can be viewed online; visual art, music and dance. It goes on to discuss the features of each of these arts activities, and to present relevant evidence from systematic reviews on the arts in dementia in general. Developing the analysis into a template for differentiating arts interventions in dementia, the paper goes on to discuss implications for future research and for the uptake of the arts by people with dementia as a means to self-care.

Interventions to reduce social isolation and loneliness among older people: an integrative review

GARDINER Clare, GELDENHUYS Gideon, GOTT Merryn
2018

Loneliness and social isolation are major problems for older adults. Interventions and activities aimed at reducing social isolation and loneliness are widely advocated as a solution to this growing problem. The aim of this study was to conduct an integrative review to identify the range and scope of interventions that target social isolation and loneliness among older people, to gain insight into why interventions are successful and to determine the effectiveness of those interventions. Six electronic databases were searched from 2003 until January 2016 for literature relating to interventions with a primary or secondary outcome of reducing or preventing social isolation and/or loneliness among older people. Data evaluation followed Evidence for Policy and Practice Information and Co‐ordinating Centre guidelines and data analysis was conducted using a descriptive thematic method for synthesising data. The review identified 38 studies. A range of interventions were described which relied on differing mechanisms for reducing social isolation and loneliness. The majority of interventions reported some success in reducing social isolation and loneliness, but the quality of evidence was generally weak. Factors which were associated with the most effective interventions included adaptability, a community development approach, and productive engagement. A wide range of interventions have been developed to tackle social isolation and loneliness among older people. However, the quality of the evidence base is weak and further research is required to provide more robust data on the effectiveness of interventions. Furthermore, there is an urgent need to further develop theoretical understandings of how successful interventions mediate social isolation and loneliness.

Dance to Health: evaluation of the pilot programme

AESOP
2017

Outlines the results of Aesop's falls prevention dance programme for older people, Dance to Health. This arts based intervention address older people's falls and problems with some current falls prevention exercise programmes, by incorporating evidence-based exercise programmes into creative, social and engaging dance activity. The programme was developed using the Aesop 7-item checklist, which lists the features an arts programme should have for it to be taken up by the health system and made available to every patient who could benefit. The report outlines the rationale for creating the programme, the outcomes achieved - in addition to reduced falls, cost effectiveness, and the wider impact of the programme. It reports that the pilot successfully brought people from the worlds of dance and older people's exercise together, was able to train dance artists in the evidence-based falls programme, and also developed six evidence-based falls prevention programmes with 196 participants. A total of 73 per cent of participants achieved the target of 50 hours’ attendance over the six months, compared with a national average for completing standard falls prevention exercise programmes of 31 per cent for primary prevention and 46 per cent for secondary prevention. Additional outcomes identified included increases in group identification, relationships and reduced loneliness, functional health and wellbeing, and mental health and wellbeing.

An exploration of the evidence system of UK mental health charities

BUCKLAND Leonora, FIENNES Caroline
2016

To investigate what may need to happen to help mental health charities make more evidence-informed decisions, this report examines how UK charities delivering mental health services currently produce, synthesise, disseminate and use evidence within their organisation. Semi-structured qualitative interviews with 12 mental health service delivery charities of varying sizes and qualitative interviews with four mental health sector experts were carried out. The project used an inclusive definition of evidence comprising: evaluation evidence, user feedback; practitioner evidence and contextual evidence (e.g., research into the prevalence or type of need). In relation to the production of evidence, the report found that mental health charities have focused primarily on producing practitioner and stakeholder evidence. Although larger charities are beginning to carry out more evaluation research, lack of resources remain a problem. It also identified little evidence produced by the charities interviewed being routinely synthesised or included in systematic reviews; weak dissemination channels; and little use of third-party evidence when making decisions. Although the number of charities interviewed was small, the report identifies some important gaps including: the need for more rigorous evaluation research about the effectiveness of charities’ interventions; the potential to make more use of existing the academic literature; and, for more evidence to be actively disseminated within the sector to enable greater learning. Recommendations to improve evidence systems are also included.

The role of case studies as evidence in public health

KORJONEN Helena, et al
2016

This study uses a mixed methods approach, comprising a literature review, a content analysis of a sample of case studies and a small number of qualitative interviews on the use and usefulness of case studies, to define, explore and make recommendations around the nature and use of case studies in public health. It suggests that case studies capture local knowledge of programmes and services, and illustrate processes and outcomes that cannot be captured in other ways, and that this is what makes them valuable. The report argues that case studies would benefit from guidelines and templates to improve the format, replicability and assessment and that they would benefit from a higher rating in evidence hierarchies as they often describe complex interventions, implementation and different contexts.

From evidence into action: opportunities to protect and improve the nation's health

PUBLIC HEALTH ENGLAND
2014

Strategic document setting out Public Health England's priorities for the next five years. The report provides a brief overview of the state of health in England today, the key health drivers, prevention plans, and future trends. It identifies and examines seven priorities for PHE working with local and central government, clinical commissioning groups and the wider NHS, universities, industry, employers, and the voluntary and community sector. These are: tackling obesity; reducing smoking; reducing harmful drinking; ensuring every child has the best start in life; reducing dementia risk; tackling antimicrobial resistance; and reducing tuberculosis.

Knowledge exchange in health-care commissioning: case studies of the use of commercial, not-for-profit and public sector agencies, 2011-14

WYE Lesley, et al
2015

The aim of this study was to explore how commissioners obtained, modified and used information to inform their decisions, focusing in particular in the knowledge obtained from external organisations such as management consultancies, Public Health and commissioning support units. In eight case studies, researchers interviewed 92 external consultants and their clients, observed 25 meetings and training sessions, and analysed documents such as meeting minutes and reports. Data were analysed within each case study and then across all case studies. Commissioners used many types of information from multiple sources to try to build a cohesive, persuasive case. They obtained information through five channels: interpersonal relationships people placement (e.g. embedding external staff within client teams); governance (e.g. national directives); copy, adapt and paste (e.g. best practice guidance); and product deployment (e.g. software tools). Furthermore, commissioners constantly interpreted (and reinterpreted) the knowledge to fit local circumstances (contextualisation) and involved others in this refinement process (engagement). External organisations that drew on these multiple channels and facilitated contextualisation and engagement were more likely to meet clients’ expectations. Sometimes there was little impact on commissioning decisions because the work of external organisations targeted and benefited the commissioning decision-makers less than the health-care analysts. The long-standing split between health-care analysts and commissioners sometimes limited the impact of external organisations. The paper concludes that to capitalise on the expertise of external providers, wherever possible, contracts should include explicit skills development and knowledge transfer components.

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