Exploring the use of social network interventions for adults with mental health difficulties: a systematic review and narrative synthesis.

BACKGROUND: People with mental health difficulties often experience social isolation. The importance of interventions to enhance social networks and reduce this isolation is increasingly being recognised. However, the literature has not yet been systematically reviewed with regards to how these are best used. This narrative synthesis aimed to investigate the role of social network interventions for people with mental health difficulties and identify barriers and facilitators to effective delivery. This was undertaken with a view to understanding how social network interventions might work best in the mental health field. METHODS: Systematic searches using combinations of synonyms for mental health difficulties and social network interventions were undertaken across 7 databases (MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science) and 2 grey literature databases (EThoS and OpenGrey) from their inception to October 2021. We included studies reporting primary qualitative and quantitative data from all study types relating to the use of social network interventions for people with mental health difficulties. The quality of included studies was assessed using the Mixed Methods Appraisal Tool. Data were extracted and synthesised narratively. RESULTS: The review included 54 studies, reporting data from 6,249 participants. Social network interventions were generally beneficial for people with mental health difficulties but heterogeneity in intervention type, implementation and evaluation made it difficult to draw definitive conclusions. Interventions worked best when they (1) were personalised to individual needs, interests and health, (2) were delivered outside formal health services and (3) provided the opportunity to engage in authentic valued activities. Several barriers to access were identified which, without careful consideration could exacerbate existing health inequalities. Further research is required to fully understand condition-specific barriers which may limit access to, and efficacy of, interventions. CONCLUSIONS: Strategies for improving social networks for people with mental health difficulties should focus on supporting engagement with personalised and supported social activities outside of formal mental health services. To optimise access and uptake, accessibility barriers should be carefully considered within implementation contexts and equality, diversity and inclusion should be prioritised in intervention design, delivery and evaluation and in future research.

Creating positive experiences of involvement in mental health research.

The importance of patient and public involvement (PPI) in mental health research is increasingly acknowledged by funders, researchers, and patients. However, the impact of PPI on those who bring their own lived experiences to research environments is underexplored. A retrospective reflective approach was undertaken collaboratively by four people bringing lived experiences of mental health difficulties to a study adapting a social network intervention for mental health services. Authors considered their experiences of involvement and how these affected them personally. We identified six characteristics of involvement that benefit not only research quality, but also people participating in PPI activities: reframing painful memories, recognising value, practising reciprocity, bridging gaps, countering stigma, and challenging established narratives. When designing and conducting research, it is important to engage empathetically with how involvement is experienced by different people. Values should be translated collaboratively into action so that unintended harms might be avoided. This Personal View offers reflections and recommendations to support this process.

Adapting a social network intervention for use in secondary mental health services using a collaborative approach with service users, carers/supporters and health professionals in the United Kingdom.

BACKGROUND: Social integration, shared decision-making and personalised care are key elements of mental health and social care policy. Although these elements have been shown to improve service user and service-level outcomes, their translation into practice has been inconsistent and social isolation amongst service users persists. AIM: To co-adapt, with service users, carers/supporters and health professionals, a web-based social network intervention, GENIE™, for use in secondary mental health services. The intervention is designed to support social activity and preference discussions between mental healthcare professionals and service users as a means of connecting individuals to local resources. METHODS: In Phase 1 (LEARN), we completed two systematic reviews to synthesise the existing evidence relating to the i) effectiveness and ii) the implementation of social network interventions for people with mental health difficulties. We undertook semi-structured interviews with a convenience sample of 15 stakeholders previously involved in the implementation of the intervention in physical healthcare settings. Interviews were also conducted with 5 national key stakeholders in mental health (e.g., policy makers, commissioners, third sector leads) to explore wider implementation issues. In Phase 2 (ADAPT), we worked iteratively with eight service users, nine carers, six professionals/volunteers and our patient and public advisory group. We drew on a framework for experience-based co-design, consisting of a series of stakeholder consultation events, to discuss the use of the social network intervention, in mental health services. Participants also considered factors that could serve as enablers, barriers, and challenges to local implementation. RESULTS: Across the stakeholder groups there was broad agreement that the social network intervention had potential to be useful within mental health services. In terms of appropriate and effective implementation, such an intervention was predicted to work best within the care planning process, on discharge from hospital and within early intervention services. There were indications that the social connection mapping and needs assessment components were of most value and feasible to implement which points to the potential utility of a simplified version compared to the one used in this study. The training provided to facilitators was considered to be more important than their profession and there were indications that service users should be offered the opportunity to invite a carer, friend, or family member to join them in the intervention. CONCLUSION: The GENIE™ intervention has been co-adapted for use in mental health services and a plan for optimal implementation has been co-produced. The next phase of the programme of work is to design and implement a randomised controlled trial to evaluate clinical and cost effectiveness of a simplified version of the intervention.

Assessing the effectiveness of social network interventions for adults with a diagnosis of mental health problems: a systematic review and narrative synthesis of impact.

BACKGROUND: Social connections have been linked to the genesis and amelioration of mental health problems and thus have potential therapeutic value. PURPOSE: To identify the current evidence base, assess risk of bias and synthesise findings on the effectiveness of social network interventions for people with mental health problems. METHODS: Electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, Cochrane Library, Web of Science, Scopus) and grey literature databases were systematically searched from inception to October 2021 using free text syntax combining synonyms for 'mental health problems' and 'social network interventions'. Articles were eligible for inclusion if they reported data from randomised controlled trials on the effectiveness of interventions designed to improve social networks for adults (18+) with mental health problems. Papers were independently reviewed for inclusion with conflicts resolved through consensus. Included papers were quality assessed and data extracted and synthesized narratively. Risk of bias was assessed using the Cochrane Risk of Bias Tool. RESULTS: Nine studies randomising 2226 participants were included. Four focused on those with a diagnosis of schizophrenia or psychosis, one on major depressive disorder and four included all types of mental health diagnoses. The current evidence base is of unclear quality. However, interventions which focused on supporting social activities appear to hold the most promise for enhancing social networks. Data on cost-effectiveness and research acceptability were limited, but suggest the potential economic feasibility of and acceptability for evaluating these interventions. CONCLUSION: There is emerging evidence that social network interventions can be effective in improving social connections for people with mental health problems. However, further evaluations with robust methodological approaches are required to inform evidence-based recommendations for health services.

The Acceptability of Physical Activity to Older Adults Living in Lower Socioeconomic Status Areas: A Multi-Perspective Study.

Older adults in lower socioeconomic status (SES) areas are the least active of all adult groups but are often absent from physical activity research. The present study aimed to elicit perspectives on acceptability of physical activity from older adults and physical activity providers in lower SES areas. Semi-structured interviews were conducted with 19 older adults and eight physical activity trainers/providers in lower SES areas. An inductive, multi-perspective Thematic Analysis was conducted. Eight themes were identified that covered one or both groups' perceptions of what was important in ensuring acceptability of activity provision. Older adults perceived a lack of value that was reinforced by lack of resources and unequal provision. Acceptability was hindered by centralisation of facilities and lack of understanding of needs by facility management. Facilitating social interaction within physical activities appeared key, thereby meeting multiple needs with fewer resources. In conclusion, to increase acceptability of physical activity for older adults in low SES areas, providers should address the lack of perceived value felt by many older adults. Equitable provision of physical activities addressing multiple needs may allow older adults with limited resources to be physically active without sacrificing other needs. Facilitating creation of social bonds may foster maintenance of physical activities.

How Do Decision Makers and Service Providers Experience Participatory Approaches to Developing and Implementing Physical Activity Interventions with Older Adults? A Thematic Analysis.

BACKGROUND: Physical activity has numerous health and well-being benefits for older adults, but many older adults are inactive. Interventions designed to increase physical activity in older adults have typically only produced small effects and have not achieved long-term changes. There is increasing interest in participatory approaches to promoting physical activity, such as co-production, co-design and place-based approaches, but they have typically involved researchers as participants. This study aimed to understand the experiences of decision-makers and service developers with the introduction of such participatory approaches when developing new physical activity programmes outside of a research setting. METHODS: Semi-structured, qualitative interviews were conducted with 20 individuals who were involved in commissioning or developing the Greater Manchester Active Ageing Programme. This programme involved funding eight local authorities within Greater Manchester, England, to produce physical activity projects for older adults, involving participatory approaches. An inductive thematic analysis was conducted, structured using the Framework approach. RESULTS: Interviewees identified important benefits of the participatory approaches. The increased involvement of older adults led to older adults contributing valuable ideas, becoming involved in and taking ownership of projects. Interviewees identified the need to move away from traditional emphases on increasing physical activity to improve health, towards focussing on social and fun elements. The accessibility of the session location and information was considered important. Challenges were also identified. In particular, it was recognised that the new approaches require significant time investment to do well, as trusting relationships with older adults and partner organisations need to be developed. Ensuring the sustainability of projects in the context of short-term funding cycles was a concern. CONCLUSIONS: Incorporating participatory approaches was perceived to yield important benefits. Interviewees highlighted that to ensure success, sufficient time needs to be provided to develop good working relationships with older adults and partner organisations. They also emphasised that sufficient funding to ensure adequate staffing and the sustainability of projects is required to allow benefits to be gained. Importantly, the implementation of these approaches appears feasible across a range of local authorities.

Conflating Time and Energy: Views From Older Adults in Lower Socioeconomic Status Areas on Physical Activity.

Perceptions of time and energy and their role in physical activity engagement were examined in older adults living in lower socioeconomic status areas. Semistructured interviews were conducted with 19 participants aged 67-94 years. A thematic framework analysis identified four themes: Time is Energy (older adults conflate time and energy in relation to physical activity), Reduced Day (engaging in activities outside a certain time frame is deemed unacceptable), Being Given Enough Time (need for time to socialize and go at own pace), and Seasonal Impact (seasonal differences affecting access). Enjoyment appears to mitigate the perceived energy drain and increase the capacity for physical activities for many. Conflation of time and energy may explain observed discrepancies between older adults' actual and perceived available time. Having locally based physical activities means less time/energy is required to attend, leaving more resources for physical activity itself. A limited availability of resources in lower socioeconomic status areas is therefore problematic.

Physicians' views and experiences of discussing weight management within routine clinical consultations: A thematic synthesis.

OBJECTIVE: To systematically search and synthesise qualitative studies of physicians' views and experiences of discussing weight management within a routine consultation. METHODS: A systematic search of four electronic databases identified 11,169 articles of which 16 studies met inclusion criteria. Quality was appraised using the Critical Appraisal Skills Programme tool and a thematic synthesis conducted of extracted data. RESULTS: Four analytical themes were found: (1) physicians' pessimism about patients' weight loss success (2) physicians' feel hopeless and frustrated (3) the dual nature of the physician-patient relationship (4) who should take responsibility for weight management. CONCLUSION: Despite clinical recommendations barriers remain during consultations between physicians and patients about weight management. Many of these barriers are potentially modifiable. PRACTICE IMPLICATIONS: Improving training, providing clearer guidelines and placing a greater emphasis on collaboration within and between clinicians will help reduce barriers for both physicians and patients. In particular, there is an urgent need for more specialised training for physicians about weight management to promote knowledge and skills in behaviour change techniques and ways to broach sensitive topics without damaging patient relationships.

The acceptability of physical activity interventions to older adults: A systematic review and meta-synthesis.

RATIONALE: Physical activity can reduce the risk of chronic illnesses, frailty and deterioration of cognitive function in older adults yet few older adults meet recommended levels of physical activity. To increase engagement in physical activity, there is a need to better understand acceptability of physical activity interventions for this population. OBJECTIVE: This article presents a systematic review and meta-synthesis of qualitative studies of independently living older adults' (≥65 years old) experiences of physical activity interventions in non-clinical contexts. METHODS: A systematic search yielded 2612 papers, of which 14 met inclusion criteria, and were synthesised using Thematic Synthesis. Inductive line-by-line coding led to the derivation of descriptive themes. An overview of the coded text allowed cross-case and within-case comparisons where both patterns and anomalies became apparent, informing the generation of analytical themes. FINDINGS: Older adults emphasised fun and enjoyment of social interaction as a motivation to be physically active. Retaining these social bonds could be important for maintenance of physical activity beyond an intervention. Doubts about capabilities or the necessity of moderate physical activity in later life were dispelled through experience of valued short-term functional and psychosocial outcomes. Relating these positive outcomes to being more active increased the perceived value of physical activity. Increased awareness of own capabilities within physical activity interventions translated into older adults being more physically active in other areas of their lives. Focusing on the role of physical activity in improving long-term health is unlikely to encourage participation of many older adults. CONCLUSIONS: To increase engagement, interventions should focus on physical activity as a fun, sociable, achievable pastime for older adults with relevant short-term benefits.