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4.
Prim Health Care Res Dev ; 19(3): 232-245, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29215328

RESUMO

This article adopts a realist approach to evaluate a social prescribing pilot in the areas of Hackney and City in London (United Kingdom). It unpacks the contextual factors and mechanisms that influenced the development of this pilot for the benefits of GPs, commissioners and practitioners, and reflects on the realist approach to evaluation as a tool for the evaluation of health interventions. Primary care faces considerable challenges including the increase in long-term conditions, GP consultation rates, and widening health inequalities. With its emphasis on linking primary care to non-clinical community services via a social prescribing coordinator (SPC), some models of social prescribing could contribute to reduce the burden on primary care, tackle health inequalities and encourage people to make greater use of non-clinical forms of support. This realist analysis was based on qualitative interviews with users, commissioners, a GP survey, focus groups and learning events to explore stakeholders' experience. To enable a detailed analysis, we adapted the realist approach by subdividing the social prescribing pathway into stages, each with contextual factors, mechanisms and outcomes. SPCs were pivotal to the effective functioning of the social prescribing service and responsible for the activation and initial beneficial impact on users. Although social prescribing shows significant potential for the benefit of patients and primary care, several challenges need to be considered and overcome, including 'buy in' from some GPs, branding, and funding for the third sector in a context where social care cuts are severely affecting the delivery of health care. With its emphasis on context and mechanisms, the realist evaluation approach is useful in understanding how to identify and improve health interventions, and analyse in greater detail the contribution of different stakeholders. As the SPC is central to social prescribing, more needs to be done to understand their role conceptually and practically.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Atenção Primária à Saúde , Encaminhamento e Consulta , Problemas Sociais , Apoio Social , Grupos Focais , Pesquisa sobre Serviços de Saúde , Humanos , Entrevistas como Assunto , Londres , Projetos Piloto , Avaliação de Programas e Projetos de Saúde , Medicina Estatal
5.
BMC Health Serv Res ; 17(1): 835, 2017 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-29258514

RESUMO

BACKGROUND: Social prescribing is targeted at isolated and lonely patients. Practitioners and patients jointly develop bespoke well-being plans to promote social integration and or social reactivation. Our aim was to investigate: whether a social prescribing service could be implemented in a general practice (GP) setting and to evaluate its effect on well-being and primary care resource use. METHODS: We used a mixed method evaluation approach using patient surveys with matched control groups and a qualitative interview study. The study was conducted in a mixed socio-economic, multi-ethnic, inner city London borough with socially isolated patients who frequently visited their GP. The intervention was implemented by 'social prescribing coordinators'. Outcomes of interest were psychological and social well-being and health care resource use. RESULTS: At 8 months follow-up there were no differences between patients referred to social prescribing and the controls for general health, depression, anxiety and 'positive and active engagement in life'. Social prescribing patients had high GP consultation rates, which fell in the year following referral. The qualitative study indicated that most patients had a positive experience with social prescribing but the service was not utilised to its full extent. CONCLUSION: Changes in general health and well-being following referral were very limited and comprehensive implementation was difficult to optimise. Although GP consultation rates fell, these may have reflected regression to the mean rather than changes related to the intervention. Whether social prescribing can contribute to the health of a nation for social and psychological wellbeing is still to be determined.


Assuntos
Medicina Geral , Atenção Primária à Saúde , Encaminhamento e Consulta , Meio Social , Isolamento Social , Adulto , Idoso , Feminino , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/economia , Pesquisa Qualitativa , Encaminhamento e Consulta/estatística & dados numéricos , Projetos de Pesquisa , Determinantes Sociais da Saúde , Inquéritos e Questionários
6.
Eur J Sport Sci ; 17(7): 904-912, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28492342

RESUMO

Multiple individual and neighbourhood characteristics are theorised to influence adult sedentary behaviour. The aim of this study was to examine associations between individual and neighbourhood-level characteristics in 40 deprived neighbourhoods in London, UK. A cross-sectional design was utilised with baseline data from the Well London Cluster Randomised Controlled Trial in 40 deprived neighbourhoods in London. Multilevel linear regression was used to examine associations between individual characteristics (measured by household survey), neighbourhood characteristics (neighbourhood audit, GIS and routinely available datasets) and sedentary behaviour (sitting time). Individual-level positive mental well-being and health behaviours were associated with sedentary time. Individual-level social networks were associated with decreased sedentary time in men and increased sedentary time in women. Neighbourhood-level measures of social networks and perceived neighbourhood quality were associated with reduced sedentary time. Fifteen per cent of the variance in sedentary time was attributable to differences at the neighbourhood level (intra-class correlation coefficient = 0.15). These findings suggest that social networks at the individual and neighbourhood levels, collective perceptions of neighbourhood quality, individual-level positive mental well-being and other health behaviours may be important components of interventions developed to reduce sedentary time in deprived populations.


Assuntos
Cognição , Comportamentos Relacionados com a Saúde , Características de Residência , Comportamento Sedentário , Comportamento Social , Adolescente , Adulto , Idoso , Estudos Transversais , Demografia , Feminino , Humanos , Modelos Lineares , Londres , Masculino , Pessoa de Meia-Idade , Apoio Social , Adulto Jovem
7.
PLoS One ; 8(12): e80127, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24312459

RESUMO

OBJECTIVES: To examine the extent to which individual and ecological-level cognitive and structural social capital are associated with common mental disorder (CMD), the role played by physical characteristics of the neighbourhood in moderating this association, and the longitudinal change of the association between ecological level cognitive and structural social capital and CMD. DESIGN: Cross-sectional and longitudinal study of 40 disadvantaged London neighbourhoods. We used a contextual measure of the physical characteristics of each neighbourhood to examine how the neighbourhood moderates the association between types of social capital and mental disorder. We analysed the association between ecological-level measures of social capital and CMD longitudinally. PARTICIPANTS: 4,214 adults aged 16-97 (44.4% men) were randomly selected from 40 disadvantaged London neighbourhoods. MAIN OUTCOME MEASURES: General Health Questionnaire (GHQ-12). RESULTS: Structural rather than cognitive social capital was significantly associated with CMD after controlling for socio-demographic variables. However, the two measures of structural social capital used, social networks and civic participation, were negatively and positively associated with CMD respectively. 'Social networks' was negatively associated with CMD at both the individual and ecological levels. This result was maintained when contextual aspects of the physical environment (neighbourhood incivilities) were introduced into the model, suggesting that 'social networks' was independent from characteristics of the physical environment. When ecological-level longitudinal analysis was conducted, 'social networks' was not statistically significant after controlling for individual-level social capital at follow up. CONCLUSIONS: If we conceptually distinguish between cognitive and structural components as the quality and quantity of social capital respectively, the conclusion of this study is that the quantity rather than quality of social capital is important in relation to CMD at both the individual and ecological levels in disadvantaged urban areas. Thus, policy should support interventions that create and sustain social networks. One of these is explored in this article. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN68175121 http://www.controlled-trials.com/ISRCTN68175121.


Assuntos
Transtornos Mentais/epidemiologia , Inquéritos e Questionários , População Urbana , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Meio Ambiente , Feminino , Humanos , Londres/epidemiologia , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Apoio Social , Fatores Socioeconômicos
8.
GeoJournal ; 77(2): 223-234, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27761059

RESUMO

The notion of community has been central to the political project of renewal of New Labour in the UK. The paper explores how the discourses of community are framed within New Labour and discusses these in the light of the results from research which focuses on how people within urban deprived areas construct their community. It draws upon the results of one part of a larger research project (the 'Well London' programme) which aimed to capture the views of residents from 20 disadvantaged neighbourhoods throughout London using an innovative qualitative method known as the 'World Café'. Our results show the centrality of young people to the development of cohesive communities, the importance of building informal relationships between residents alongside encouraging greater participation to policy making, and the need to see these places as fragile and temporary locations but with considerable social strengths. Government policies are only partially addressing these issues. They pay greater attention to formally encouraging citizens to become more involved in policy making, largely ignore the contribution young people could make to the community cohesion agenda, and weakly define the shared norms and values that are crucial in building cohesive communities. Thus, the conclusion is that whilst an emphasis of the government on 'community' is to be welcome, more needs to be done in terms of considering the 'voices' of the community as well as enabling communities to determine and act upon their priorities.

9.
Community Dev J ; 47(2): 168-183, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27746483

RESUMO

There has been much enthusiasm over the past 10 years for the potential contribution of social enterprises to the regeneration of disadvantaged urban areas. This enthusiasm has far outstripped the availability of empirical evidence. This paper reports a qualitative study of one social enterprise, a community café, and its contribution to building social capital in a disadvantaged urban area in London. The analysis reveals how the café builds 'bonding' and 'bridging' social capital whilst also addressing 'downside' social capital. Overall, the manager of the social enterprise played a considerable role in facilitating the development of social capital, thus emphasising the importance of individuals and their attitudes, skills, and background in urban regeneration. However, the role of the social enterprise in building 'linking' social capital was minor. In this instance, more effective mechanisms of community engagement need to be put in place in order to empower local residents and organisations.

10.
Health Place ; 17(5): 1023-9, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21784693

RESUMO

There has been extensive conceptual and empirical work on the associations between social relations and health in recent years. However, the specific pathways through which social interactions impact on health have not been fully elucidated. The aim of this paper is to estimate associations between Leisure Time Physical Activity (LTPA) and social networks and support. Using data from a cross-sectional household survey in 40 disadvantaged lower super-output areas in London, we applied a multilevel model to investigate psychosocial and environmental determinants of physical activity in these populations. Our findings present a strong case for the influence of individual-level social networks on the level of LTPA, although the associations between the types of social support and LTPA were insignificant. We also found that crime rate was an important area-level correlates of LTPA.


Assuntos
Exercício , Atividades de Lazer , Áreas de Pobreza , Apoio Social , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Londres , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
Groupwork ; 20(3): 32-50, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-27857453

RESUMO

The Well London programme was launched across twenty boroughs in London during late 2007 to improve the health and well-being of residents living in some of the most deprived communities in London. Well London employed a multi-stage community engagement process which informed the overall project strategy for each intervention area. In this article we establish and describe the key principles that guided the design of this innovative community engagement process. Principles included building collaborative partnerships, working with whole-systems, privileging community knowledge and working with the deficit of experience in each area. The article then describes in detail how these principles were operationalised throughout the preparation and delivery of forty World Cafes, which were the first open community activities of the Well London community engagement process. Finally, this article reflects on and summarises the lessons learned when employing innovative, inclusive and transparent community engagement for health promotion.

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