Promoting health and innovative health promotion practice through a community arts centre

The salubrious effects of participation in and exposure to the arts are well documented. This paper describes the development of a unique arts centre established in a disadvantaged urban school setting as part of a larger community-based health promotion research project. The discussion highlights how community-based arts programming may impact health not only through positive effects on "upstream" non-medical health determinants, particularly aspects of social support, but also through its ability to facilitate the more traditional health-promotion initiatives of the larger parent project. Also discussed is this centre's potential to act as a catalyst to achieve the overarching project goal of enhanced community health by building constitutive capacity around positive aspects of the community, rather than focusing on capacity only as an instrumental resource to solve social or health problems. Greater incorporation of the arts within health-promotion projects offers potential to enhance both health promotion practice and outcomes.     

Community-Initiated Urban Development: An Ecological Intervention

Neglected urban environments have been linked to social isolation, depression, and other health problems. In Portland, OR in 2003, an intervention was implemented and evaluated in three neighborhoods with the objective of promoting community participation in urban renewal and engaging residents in the construction of attractive urban places. Municipal officials approved and permitted community-designed street murals, public benches, planter boxes, information kiosks with bulletin boards, trellises for hanging gardens, all positioned in the public right-of-way. Residents within a two-block radius of the three sites were systematically sampled and interviewed before (N = 325) and after (N = 349) the intervention, of which, 265 individuals completed both surveys of the panel study. After the intervention, multivariate results revealed improvements in mental health (p = 0.03), increased sense of community (p < 0.01), and an overall expansion of social capital (p = 0.04). Through community empowerment, participation, and collective action, the strategy successfully engaged residents in restoring neighborhoods, with direct benefits to community well-being.     

Can arts projects improve young people’s wellbeing? A social capital approach

Community arts projects are widely believed to have positive impacts on health, wellbeing and social inclusion. Such beliefs underpinned the UK Government-funded SingUp programme for children. Drawing on data from participant observation, extended interviews, focus groups and a questionnaire survey, we examine the experiences of children in three SingUp choirs. We focus specifically on social and emotional wellbeing as they relate to social capital: this being one of the key pathways through which arts participation is thought to impact on health and wellbeing more widely. For many (particularly girls from relatively privileged backgrounds), the experience has been largely positive, providing opportunities to develop social capital, make new friends and build confidence. However, others’ experiences have been more equivocal, entailing risks of disconnection from existing networks of friends. We argue that, while arts projects can impact positively on young people’s social and emotional wellbeing, we cannot assume that the changes will be unequivocally good or straightforward. We follow Bourdieu and other critical theorists in arguing that social capital operates in association with economic and cultural capital, and cannot be understood in isolation from the wider constraints of people’s lives.     

Homeless adults engagement in art: first steps towards identity, recovery and social inclusion

Background: The Australian policy on homelessness identifies participation in structured activities as the first step towards social inclusion and increasing the likelihood of permanently leaving a homeless lifestyle. Art interventions increase interpersonal function and social participation and provide a means of expression and transformation with people who are homeless. Aim: This study explores the value of an art programme provided by a non‐government agency for homeless adults. Method: Qualitative methods including participant observation and purposive interviews were analysed inductively and thematically to gain an understanding of the participants’ experience of art and its value. Interviews with stakeholders provided additional information and triangulation of the data. Results: The study demonstrates that art occupations provide a starting point for participation in community and a positive experience that encourages the construction of new identities, routines and roles. Furthermore, art provides an alternative from the problems associated with homelessness, mental health and substance abuse and allows for public recognition and social inclusion. Conclusions: Health professionals should work towards the social inclusion of homeless people through providing occupational opportunities for participation in safe settings as a first step to community engagement.     

Strengthening community mental health competence—A realist informed case study from Dehradun,North India

Few accounts exist of programmes in low‐ and middle‐income countries seeking to strengthen community knowledge and skills in mental health. This case study uses a realist lens to explore how a mental health project in a context with few mental health services, strengthened community mental health competence by increasing community knowledge, creating safer social spaces and engaging partnerships for action. We used predominantly qualitative methods to explore relationships between context, interventions, mechanisms and outcomes in the “natural setting” of a community‐based mental health project in Dehradun district, Uttarakhand, North India. Qualitative data came from focus group discussions, participant observation and document reviews of community teams' monthly reports on changes in behaviour, attitudes and relationships among stakeholder groups. Data analysis initially involved thematic analysis of three domains: knowledge, safe social spaces and partnerships for action. By exploring patterns within the identified themes for each domain, we were able to infer the mechanisms and contextual elements contributing to observed outcomes. Community knowledge was effectively increased by allowing communities to absorb new understanding into pre‐existing social and cultural constructs. Non‐hierarchical informal community conversations allowed “organic” integration of unfamiliar biomedical knowledge into local explanatory frameworks. People with psycho‐social disability and caregivers found increased social support and inclusion by participating in groups. Building skills in respectful communication through role plays and reflexive discussion increased the receptivity of social environments to people with psycho‐social disabilities participation, thereby creating safe social spaces. Facilitating social networks through groups increases women's capacity for collective action to promote mental health. In summary, locally appropriate methods contribute most to learning, stigma reduction and help‐seeking. The complex social change progress was patchy and often slow. This study demonstrates a participatory, iterative, reflexive project design which is generating evidence indicating substantial improvements in community mental health competence.     

Reframing “participation” and “inclusion” in public health policy and practice to address health inequalities: Evidence from a major resident‐led neighbourhood improvement initiative

There is a need for greater conceptual clarity in place‐based initiatives that seek to give residents of disadvantaged neighbourhoods more control over action to address the social determinants of health inequalities at a local level. In this article, we address this issue as it relates to the concepts of participation and inclusion. We draw on qualitative data generated during the first phase of the Communities in Control Study, a longitudinal multisite independent evaluation of the impact of Big Local on the social determinants of health and health inequalities. Big Local is a resident‐led area improvement initiative in England, funded by the UK Big Lottery Fund. Initiatives focused on community empowerment are increasingly prominent in public health policy and practice globally. Approaches emphasise the promotion of greater control over decisions and action among individuals, groups, and communities, particularly those living in disadvantaged circumstances. However, when it comes to participation and inclusion in taking action and making decisions, the field is characterised by conceptual confusion. This risks undermining the impact of these initiatives. While participation and inclusion are necessary conditions for empowerment and collective control, they are not necessarily sufficient. Sufficiency requires attention to the breadth of participation (i.e., to inclusion) and to the depth of participation (i.e., the extent to which it is experienced as empowering and ultimately enables the exercise of collective control over decisions and actions). In observing how different Big Local resident‐led partnerships across England are tackling the day‐to‐day challenges of engaging with their communities, we reveal the potential for policy and practice of reframing, and therefore clarifying (to highlight the different roles they have) the concepts of participation and inclusion in terms of depth and breadth.     

From concept to practice: including the social determinants of health in environmental assessments

The present paper examines the historical evolution of health impact assessments as part of the environmental assessment process. The development of a coherent public health framework must be based on the model of determinants of health, integrating toxic and infectious risks and social impacts of projects. The integration of common concepts, processes and methodologies from the area of public health and social impact assessment challenges the quantitative model approach to risk assessment. The expert-driven risk assessment is transformed into a social learning process where local knowledge and scientific input foster a dialogue among stakeholders. The issue-oriented, iterative and participative assessment process may be applied to the health impact assessment of public policies. Sustainable development with its social objectives of empowerment, participation, equity, poverty alleviation, social cohesion, population stability and institutional development is an appropriate framework for conducting health impact assessments.     

西南地区老年人社会参与对生命质量的影响研究

目的 了解西南地区老年人社会参与现状，并以生命质量作为评价健康的指标，分析社会参与对老年人健康的影响。方法 利用2016—2017年在成都市和昆明市进行的入户调查数据，选取60岁及以上调查对象共3 698名。从有组织的活动参与、人际交往及参与群体性锻炼三个方面分析老年人的社会参与状况，并运用多因素logistic回归分析老年人的社会参与对生命质量的影响。结果 被调查对象人际交往总体较好，参与群体性锻炼较差。多因素分析显示，人际交往中的关系密切的朋友数量（OR = 1.476 及OR = 2.029）及家庭关系（OR = 1.241 及OR = 2.140）对躯体生命质量及心理生命质量均有影响；有组织的活动参与中的社会团体活动参加情况（OR = 1.482）仅对躯体生命质量有影响；有组织的活动参与中的“小区公共项目不直接对您有利时是否会参与”（OR = 1.298）以及参与群体性锻炼（OR = 1.608）对心理生命质量有影响。结论 老年人的社会参与对其生命质量有较为明显的影响。政府及社区对老年人的社会参与应该给予更多的关注。     

Promoting social inclusion for young people affected by psycho-social disability in India – a realist evaluation of a pilot intervention

ABSTRACT

India has 600 million young people, more than any other country in the world. Mental illness is the leading burden of disease for young people, and those affected experience restrictions in social participation that compromise recovery. The aim of this study was to assess the impact of a peer-led, community-based, participatory group intervention on social inclusion and mental health among 142 young people affected by psycho-social disability (PSD) in Dehradun district, Uttarakhand. Qualitative data were obtained via in-depth interviews and focus-group discussions. A realist evaluation identified contextual factors, mechanisms and outcomes to develop the programme theory. Group participants described intermediate outcomes including establishment of new peer friendship networks, increased community participation, greater self-efficacy (for young women particularly), and improved public image (for young men) that are likely to have contributed to the primary outcomes of greater (self-perceived) social inclusion and improved mental health (as assessed quantitatively). Mechanisms were identified that explain the link between intervention and outcomes. These findings demonstrate the effectiveness of a brief intervention to improve mental health and social inclusion for young people with PSD and are potentially relevant to programme implementers and policy-makers working with young people and promoting social inclusion, in other low- and middle-income settings.     

Evaluating projects funded by the Western Australian Health Promotion Foundation: first results

The paper describes output measures of performance of the WesternAustralian Health Promotion Foundation (Healthway), using asystem known as graduated project evaluation (GPE). Resultsare reported at the basic and process levels of evaluation on588 health and sponsorship projects, and at the impact levelbased on surveys of 5710 spectators and participants at 53 sport,arts and racing events sponsored by Healthway funds. At thebasic and process levels the average Healthway project reached7449 people directly and generated media coverage of healthmessages on 27.3 occasions. It secured, on average, 0.99 healthystructural reforms in recreational or cultural venues, involvedthe participation of local community members in project administrationin 38% of instances, and provided 1596 person-hours of healtheducation. Non-smoking, safe drinking, nutrition, exercise,sun protection, safe sex and injury prevention health messageswere promoted using 24 different types of sponsor benefits.Of the 5710 respondents surveyed post-event, 67% were awareof the promoted health message and 82% of these understood whatthe message meant. Four per cent of all respondents intendedto take action ranging from seeking information to adoptingthe health behaviour. A comparison of the cost-effectivenessof small and large sponsorship projects is given to illustratethe use of GPE to inform funding decisions. Smaller projectsoutperformed larger projects on all available indicators. Wediscuss the peculiar features of the health promotion foundationconcept, methods to improve its performance and implicationsfor future research.     

关于《教育部等五部门关于全面加强和改进新时代学校卫生与健康教育工作的意见》的专家解读促进学生心理健康的三大抓手——体育、艺术和游戏活动

教育部等五部门印发了《关于全面加强和改进新时代学校卫生与健康教育工作的意见》,提出了要强化学生的心理健康教育,培养学生积极的心理品质,维护心理健康。针对促进学生心理健康的目标,本论文提出了三项策略,认为心理健康的促进应在心理之外下功夫,即体育、艺术和游戏活动。其一,学生热衷于参与社交体育活动,而社交体育能够有效提高学生的心理健康水平。其二,学校可通过开设绘画、雕刻、建筑、音乐、舞蹈、戏剧、电影等艺术欣赏课程,提高学生的艺术修养从而促进其心理健康。其三,游戏活动是人类成长的乐园和阶梯,学校应该开展适合不同年龄段学生的游戏活动,让学生们自己去发现、感悟、体验和应对自己的内心深处的心理需求,学会处理人际关系、适应和融入社会生活,更好地提高学生的心理健康。为促进学生的心理健康的发展,建议学校应当开展社交体育、开设艺术欣赏课程和设计符合不同年龄段的参与式和体验式的游戏活动。     

Outcomes of a Life Skills Intervention for Homeless Adults with Mental Illness

A manualized life skills intervention based on empowerment theory and situated learning was tested on 51 homeless adults with mental illness living in emergency or single room occupancy housing. The intervention improved skills in food, money, room, and self-care management and safe community participation. Participation included baseline measures with intervention post-tests and three and six month follow up measures. Comparisons were made to examine effectiveness between modules. There were significant improvements over time for the room and self-care and safe community participation modules, whereas the other modules did not reach statistical significance. The results suggest that through intervention this population may develop and retain the life skills needed to maintain residential stability.     

A mixed‐methods evaluation of a Recovery College in South East Essex for people with mental health difficulties

Recovery Colleges aim to assist people with mental health difficulties in the journey to recovery through education. They bring together professional and lived experience of mental health challenges in a non‐stigmatising college environment and operate on college principles. All courses are designed to contribute towards well‐being and recovery. Despite the ever‐growing number of Recovery Colleges (both in the UK and internationally), the evaluative evidence is limited; comprising mostly non‐peer‐reviewed evaluations, audits and case studies. The present article comprises a mixed‐methods evaluation of a newly established Recovery College in South East Essex, UK. The evaluation comprised questionnaires of mental well‐being and social inclusion at baseline and 3 and 6 month follow‐up, in addition to three focus groups. There were significant improvements in both mental well‐being and social inclusion from baseline to 6 month follow‐up (25 participants completed the measure of well‐being at both time points and 19 completed the measure of social inclusion). This was supported by additional free‐text questionnaire comments and focus group findings (17 participants participated across the focus groups), with reports of increased confidence, reduced anxiety and increased social inclusion/reduced social isolation. Additionally, at 6 month follow‐up a majority of respondents were planning on attending courses external to the Recovery College, volunteering and/or gaining paid employment. Challenges and recommendations identified through the focus groups indicate the importance for standardisation of processes (which is particularly important when multiple organisations are involved in the running of a Recovery College), as well as consideration of longer‐running courses. Funders should continue to invest in the Recovery College movement as the growing evidence‐base is demonstrating how these colleges can help address the high prevalence of mental health difficulties, by promoting mental well‐being and social inclusion.     

Group-based microfinance for collective empowerment: a systematic review of health impacts

ObjectiveTo assess the impact on health-related outcomes, of group microfinance schemes based on collective empowerment.MethodsWe searched the databases Social Sciences Citation Index, Embase, MEDLINE, MEDLINE In-Process, PsycINFO, Social Policy & Practice and Conference Proceedings Citation Index for articles published between 1 January 1980 and 29 February 2016. Articles reporting on health impacts associated with group-based microfinance were included in a narrative synthesis.FindingsWe identified one cluster-randomized control trial and 22 quasi-experimental studies. All of the included interventions targeted poor women living in low- or middle-income countries. Some included a health-promotion component. The results of the higher quality studies indicated an association between membership of a microfinance scheme and improvements in the health of women and their children. The observed improvements included reduced maternal and infant mortality, better sexual health and, in some cases, lower levels of interpersonal violence. According to the results of the few studies in which changes in empowerment were measured, membership of the relatively large and well-established microfinance schemes generally led to increased empowerment but this did not necessarily translate into improved health outcomes. Qualitative evidence suggested that increased empowerment may have contributed to observed improvements in contraceptive use and mental well-being and reductions in the risk of violence from an intimate partner.ConclusionMembership of the larger, well-established group-based microfinance schemes is associated with improvements in some health outcomes. Future studies need to be designed to cope better with bias and to assess negative as well as positive social and health impacts.     

Empowerment versus power: consumer participation in mental health services

Consumer participation is regarded as increasingly important in the effective delivery of mental health services and for the empowerment of mental health consumers. In a qualitative study, 17 consumers and 10 occupational therapists discussed their perceptions of consumer participation in mental health services. These included the advantages and benefits of consumer participation, the barriers to participation and how health workers can facilitate participation. The research brought to light an uncertain relationship between empowerment and power. While empowerment was universally considered to be desirable, opinions about the transfer of power were more ambivalent. It is argued that consumers and health workers need to work together to find creative ways of addressing concerns relating to power so that real power can be shared to benefit all consumers. Limitations of the study included the small sample size and the sampling method, which restricted access to potential participants. Further research is suggested into consumer participation and consumer power. Copyright © 1999 Whurr Publishers Ltd.     

Perceptions of community participation and health gain in a community project for the South Asian population: a qualitative study

BACKGROUND: The new public health rejects old individualist attempts at improving health and embraces community-based approaches in reducing health inequalities. Primary Care Trusts in England face the challenge of converting community participation in health into reality. This study explores differences in perception of participation between lay and professional stakeholders of a community health project for a South Asian population in Greater Manchester. METHODS: In-depth interviews and focus groups were used to explore the views of professional and lay stakeholders. All data were audio-taped, transcribed and analysed for emerging themes using a qualitative framework. RESULTS: Professionals talked of working in partnership with the community but lay stakeholders did not feel that they had control over the project. There were problems in engaging the community and local health professionals in the project. Lack of cultural awareness hampered participation in the project. There was agreement that the project improved the self-confidence of participants and created a more informed population. However, there was little support for claims of improvements in social cohesion and changes in lifestyle directly as a result of the project. CONCLUSION: Converting the rhetoric of community participation in health into reality is a greater challenge than was envisaged by policy makers. Marginalized communities may not be willing participants and issues of language and cultural sensitivity are important. Project outcomes need to be agreed to ensure projects are evaluated appropriately. Projects with South Asian communities should not be seen to be dealing with all 'ethnic health' issues without addressing changes in statutory organizations and other wider social determinants of health.     

上海精神病人社区干预研究

目的对上海某社区精神病人进行社区干预并评价干预效果,探讨提高精神病患者健康状况的有效措施。方法整群抽取上海田林社区,以该社区2007年4月筛查出的精神病患者322例为研究对象,对其提供咨询、心理干预、个案服务、免费提供抗精神病药物,同时采取有目的的随访、管理,3年后对干预前后患者康复措施落实率、精神卫生知晓率、患者依从率、病情改善率、社会参与率、肇事肇祸率等指标进行对比分析。结果社区干预使康复措施的落实率由51.9%上升到98.8%(P﹤0.001);知晓率由44.1%上升到86.3%(P﹤0.001);患者依从率从干预前的41.0%上升到干预后的84.8%(P﹤0.001);病情控制率由24.2%上升到86.0%(P﹤0.001);社会参与率由39.8%上升到64.0%(P﹤0.001);精神病人肇事肇祸率由3.4%下降到0.6%(P﹤0.001)。结论社区干预能显著提高精神病患者的健康状况同时给社会带来稳定。     

南水北调中老年移民心理干预效果分析

摘要:目的 探索南水北调中老年移民群体的心理干预效果及其心理健康、社会心理应激、社会支持的关系。方法 采用分层整群抽样,将辉县、荥阳、宝丰3个安置地的35岁以上991名中老年移民进行为期2年的心理干预。实验组移民进行心理健康讲座以及个体及团体心理咨询、心理治疗、建议精神科治疗3个层次的心理干预,对照组移民仅接受定期的心理健康讲座和团体心理咨询,干预前后均对2组移民使用心理健康状况自评量表（SCL-90）、心理社会应激调查表（PSSG）以及社会支持评定量表（SSRS）进行心理测量。结果 (1)经过不同的干预处理后,2组移民心理的健康状况自评量表(SCL-90)在躯体化、强迫症状、人际关系敏感、抑郁、焦虑、敌对等10个因子得分及总分上差异均有统计学意义(P＜0.05);心理社会应激调查表(PSSG)的得分除积极情绪体验因子的得分差异无统计学意义以外(Z=-1.587,P=0.112),生活事件、消极情绪体验、消极应对、积极应对因子以及总分上差异均有统计学意义(P＜0.05);社会支持评定量表(SSRS)除在客观支持因子上的得分差异无统计学意义以外(t=-0.738,P=0.461),主观支持、对支持的利用度因子以及总分上差异均有统计学意义(P＜0.05)。(2)关联规则模型和神经网络模型分析结果显示,中老年移民的社会支持、心理社会应激以及心理健康有较强的关联性,并且较低的社会支持和较高的心理社会应激会对中老年移民的心理健康产生不利影响。结论 接受3层次心理干预等措施的实验组中老年移民心理状况好于对照组中老年移民。中老年移民的心理健康受社会心理应激、社会支持的影响较大。因此,调动移民的主观积极情绪,引导积极应对方式,提高主观社会支持感是增强中老年移民心理健康的关键举措。     

Relationships of self-reported physical health, sociability, and spiritual life with mental health: an investigation according to gender and life stage

OBJECTIVE: To investigate the relationships of self-reported physical health, social and spiritual satisfactions with subjective mental health according to gender and life stage. METHODS: Self-reported questionnaires with questions regarding subjective health status and lifestyles were sent to 1905 community residents aged 20 years or older selected by random sampling in Wakayama Prefecture, Japan. Subjective mental health, physical health, social and spiritual satisfactions as measures of subjective health status were assessed using a visual analogue scale. Multiple logistic regression analysis was used to evaluate the relationships between the subjective mental health and the other three components of the subjective health status with adjustment for life style factors related to the subjective mental health in the subjects without missing values of relevant factors (n=1,752). The subjects were divided into three life stages depending on their ages: young (20-39), middle (40-59), and old (60 or more). RESULTS: Overall, the poor statuses of the three components, namely, physical health, social and spiritual satisfactions, were significantly associated with poor mental health in both genders at any life stage. However, detailed analysis revealed some interesting characteristics. In young men, social dissatisfaction was strongly associated with poor mental health whereas spiritual dissatisfaction in addition to social dissatisfaction was strongly associated with poor mental health in young women. In the middle aged group, both social and spiritual dissatisfactions were strongly associated with poor mental health in both genders. On the other hand, poor physical health status was strongly associated with poor mental health in the old aged group. CONCLUSIONS: These results suggest the importance of the mental health interventions under consideration for each life stage and gender.     

儿科护士压力应对和社会支持与心理健康的关系

目的：研究儿科护士压力应对方式、社会支持与心理健康的关系,为进行循证团体心理干预寻找理论支持。方法采取分层抽样的方法,使用一般情况调查表、症状自评量表（ SCL-90）、应对方式问卷和社会支持评定量表对福建省福州儿童医院临床科室护士111名进行问卷调查。结果17．82％的儿科护士心理健康筛查阳性,比中国常模高（χ2＝4．36,P＜0．05）。客观支持、主观支持、支持利用度及解决问题型的压力应对方式均与SCL-90总分存在极其显著的负相关（ r值分别为-0．27、-0．38、-0．24、-0．40,均P＜0．01）;自责型及幻想型的压力应对方式与SCL-90总分存在显著的正相关（r＝0．37,P＝0．00;r＝0．26,P＝0．02）;解决问题型应对方式与社会支持三维度均显著正相关（r值分别为0．27、0．44、0．26,均P＜0．01）,求助型应对方式与支持利用度显著正相关（r＝0．32,P＝0．00）,而退避型应对方式与主观支持显示负相关（r＝-0．28,P＝0．02）。结论不同的压力应对方式及社会支持程度与儿科护士的心理健康状况显著相关,尤其是解决问题型应对方式及主观支持水平高的儿科护士,心理健康状况较好。主观支持程度能显著预测儿科护士的心理健康状况。