Research and evaluation - Evaluation - Upstream

Research and evaluation

Independent academic evaluation was a vital part of the Upstream project from the outset. Funding for research by the Peninsula Medical School and Mid Devon Primary Care Research Group was built into the original bid. Mid Devon Primary Care Trust, Devon Social Services and the Centre for Evidence Based Social Services (CEBSS) were consulted in developing research protocols (ensuring that the research tackled the most relevant questions), and formed an Advisory Group to monitor progress.

Pilot Project

Summer 2002 - Spring 2003: 9-month Pilot Project, involving a group of participants demonstrated the feasibility of a mentoring approach to encourage elderly and socially isolated people to engage in social /creative activities. Feedback on processes, problems and solutions was used to inform the subsequent Upstream service model. Questionnaires were piloted for acceptability and individual sensitivity, leading to selection of outcome measures for the following research stages. Report (Spring 2003).

Action Research

Summer 2003 – Summer 2005: Action Research (Report October 2005). Mentors distributed approved questionnaires (SF12 and Geriatric Depression Scores – GDS) to participants and a Researcher based at PMS held in-depth interviews with a range of stakeholders (participants, Upstream staff, strategic partners) used to improve Upstream’s delivery processes. Participants could still benefit from the Upstream service, even if they did not wish to be involved in the research. The feedback identified barriers to and facilitators of successful intervention, as well as insights into the psychological /inter-personal processes which generate positive change.

An Interim Report was produced in January 2005 which identified improved psychological well-being and a high level of satisfaction. Vital elements of the intervention were improved social integration, self-efficacy (confidence-building) and self-concept (perceived identity and social roles). Other specific barriers and bridges to successful intervention included venue, social context, transport, first impressions /quality of initial activities. Key issues in the sustainability of activities were transport, availability of community-based activities; self-efficacy (confidence to organise their own groups, and/or to pro-actively seek further activities in the community), and self-concept (e.g. concerns about ‘fitting in’ to existing community-based groups.

Existing research literature was reviewed and helped to strengthen and develop the theoretical basis underpinning the Upstream approach. The key principles included building self-efficacy; empowering participants /self-determination; enhancing self-concept through developing positive social (group) identities and perhaps through developing previously untapped creative talents; building social networks, accounting for individual context through mentoring (i.e. tailored rather than one-size-fits-all approach). Enhancing the individual ‘meaningfulness’ or relevance of the activities and community participation also seems to be an important cross-cutting theme. For example, those who perceived they were helping others seem to benefit particularly.

PMS Report, October 2005

“Overall, Upstream seems to have been highly successful in identifying and engaging with their target socially isolated elderly population. The majority of participants at entry to Upstream were living alone, and substantial psychological and physiological morbidity was evident, including a 53% prevalence of depression and high rates of chronic illness and disability. Overall quality of life for both mental and physical well-being was well below the expected normative, age-matched population values. In terms of outcomes, putting the qualitative and quantitative data together suggests that the intervention is delivering significant and clinically meaningful benefits to this population.

“The results suggest that engaging socially isolated elderly people in social and creative activities, using an individually tailored, mentoring approach, which focuses on building efficacy /confidence and self-determination can enhance their overall health-related quality of life, with a particularly impact on depression, as well as increasing perceived social support. Additional physical health benefits may be possible, particularly in the longer term if activities are sustained. The extent of the possible health gains is clinically meaningful in terms of the average changes in outcome scores reported. Furthermore, a substantial number of individuals were reported to experience quite radical transformations, including enhanced psychological well-being and lifestyle changes, as well as physical health benefits.”

“Against an expected picture of decline in both physical and mental health in this age group, overall health seems to be improving in this population, with stronger short term benefits in psychological well-being, and longer-term benefits in terms of depression, physical health and perceived social support.”

‘The intervention seems to coincide with improvements in other health-related behaviours, such as greater attention to diet, a reduction in some people’s alcohol consumption, and an increase in the amount and type of exercise people engaged in. One reason why Upstream may work especially well with those suffering from depression is that it appears to alleviate some symptoms by socially integrating previously isolated people and providing a reason for getting out of bed.’

Unique Aspects of Upstream:

• Networking /multi-method approach identifies socially isolated people
• Individual tailoring enhances engagement in activities and sustainability
• Mentoring ‘holds’ participants as long as needed to effect sustainable change
• Underlying philosophy of empowerment, building confidence, self-determination. Consistent with drive towards self-management and away from dependence on health /social services
• Veterans feed back into activity groups, increasing social capital.
  

School of Education & Lifelong Learning, University of Exeter

‘A Position Paper: Creativity, older people and health’ by Christine Bennetts, Cathie Holden and Keith Postlethwaite is published in the International Journal of Health Promotion & Education, Vol. 43 Number 4, 2005, 125-130. This includes material on the School of Education & Lifelong Learning’s work with Upstream.