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Results for 'evidence-based practice'

Results 1 - 10 of 22

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.

The effectiveness of mindfulness- and acceptance-based interventions for informal caregivers of people with dementia: a meta-analysis

COLLINS Rebecca N., KISHITA Naoko
2019

Background and Objectives: The application of mindfulness- and acceptance-based interventions (MABIs) for informal caregivers of people with dementia (PwD) is relatively novel, and the current state of the evidence base is unclear. This meta-analysis examined the effectiveness of MABIs on reducing symptoms of depression and burden in informal caregivers of PwD. The quality of included studies was evaluated and moderator variables explored. Research Design and Methods: A literature search of six electronic databases (PsycARTICLES, PsycINFO, MEDLINE Complete, SCOPUS, Web of Science, and ProQuest) was conducted from the first available date to 20 December 2016. Inclusion criteria involved studies that quantitatively investigated the impact of MABIs on depression and/or burden in informal caregivers of PwD. Results: Twelve studies, providing data on 321 caregivers, were included. Most used mindfulness-based stress reduction and were conducted in the United States. The average attrition among participants was 15.83%. The pre–post effect of MABIs was large for depression and moderate for burden. These effects were largely maintained at follow-up. Significant heterogeneity of effect sizes was observed, with no significant moderators identified. Study quality varied from very poor to moderately good. Discussion and Implications: The low attrition and moderate to large effects suggest that MABIs are acceptable and beneficial for informal caregivers of PwD. The lack of significant moderators could advocate services using more cost-effective forms of MABIs. Further higher-quality research is needed to improve the robustness of the evidence base and enable a meta-analysis to thoroughly examine and quantify moderator variables.

Physical activity programs for older people in the community receiving home care services: systematic review and meta-analysis

BURTON Elissa, et al
2019

The proportion of older adults is increasing around the world and most wish to live in their home until they die. To achieve this, many will require services in the home to remain living independently. To maintain function (ie, strength, balance, and endurance), physical activity needs to be undertaken on a regular basis, and is essential as a person ages. Unfortunately, as people age there is a tendency to reduce activity levels, which often leads to loss of function and frailty, and the need for home care services. This updated systematic review includes a mix of study methodologies and meta-analysis, and investigated the effectiveness of physical activity/exercise interventions for older adults receiving home care services. Eighteen studies including ten randomized controlled trials meeting the selection criteria were identified. Many of the studies were multi-factorial interventions with the majority reporting aims beyond solely trying to improve the physical function of home care clients. The meta-analysis showed limited evidence for effectiveness of physical activity for older adults receiving home care services. Future exercise/physical activity studies working with home care populations should consider focusing solely on physical improvements, and need to include a process evaluation of the intervention to gain a better understanding of the association between adherence to the exercise program and other factors influencing effectiveness.

Non-pharmacological interventions for people with dementia: a review of reviews

MEYER Claudia, O'KEEFE Fleur
2018

Objective: Aged care services increasingly respond to the needs of people with dementia. Non-pharmacological approaches are preferable to reduce responsive behaviours, improve/maintain functional capacity and reduce emotional disorders. This rapid review of systematic reviews aimed to consolidate the evidence for non-pharmacological interventions and determine outcome effectiveness. Methods: Systematic review literature was comprehensively searched for non-pharmacological interventions for dementia in residential care. Quality ratings used adapted GRADE methodology, and ease of implementation assessed. Results: Of 629 abstracts screened, 81 full-text articles were retrieved, 38 articles included. The strongest evidence for reducing responsive behaviours was music, sensory stimulation, simulated presence and validation therapies. Exercise and light therapy improved/maintained activities of daily living, while cognitive stimulation and reminiscence improved cognition. Strongest evidence for reducing emotional disorders was music, psychological interventions and reminiscence. Conclusion: Much evidence of varying quality exists, with resource-constrained residential care providers now able to make evidence-based decisions about non-pharmacological interventions.

Results 1 - 10 of 22

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News

Moving Memory

Moving Memory Practice example about how the Moving Memory Dance Theatre Company is challenging perceived notions of age and ageing.

Chatty Cafe Scheme

Chatty Cafe Scheme Practice example about how the Chatty Cafe Scheme is helping to tackle loneliness by bringing people of all ages together

Oomph! Wellness

Oomph! Wellness Practice example about how Oomph! Wellness is supporting staff to get older adults active and combat growing levels of social isolation

KOMP

KOMP Practice example about how KOMP, designed by No Isolation is helping older people stay connected with their families

LAUGH research project

LAUGH research project Practice example about a research project to develop highly personalised, playful objects for people with advanced dementia
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