Health & Social Care in the Community

Social prescribing link workers interventions have been widely adopted within healthcare systems, particularly in the UK, to support a range of patients’ needs and to help improve condition management for those living with multiple long-term conditions. However, there is a lack of consistency in implementation and unclear guidance about how social prescribing link workers might address these needs, particularly in individuals living with physical and mental health long-term conditions who bear a greater burden of multifaceted everyday problems and health challenges. This review aimed to identify the existing ways in which link workers might support the needs of this group. Systematic literature search strategies were carried out with a systematic methodology that identified 18 eligible articles that mostly consisted of qualitative studies (N = 10) with the remaining studies employing a range of designs. Following a thorough process of data extraction and synthesis of findings, two principal themes and four subthemes were developed that together helped to explain the process of support and the enablers that determined how successful link workers’ interventions were in supporting adults with physical and mental health long-term conditions. We found that personalised plan development and goal setting was a central collaborative task between the link worker and the patient that helped in “linking” people to beneficial and relevant sources of support. However, the catalyst for a successful change appears to be a combination of a therapeutic relationship with a link worker facilitated by a range of practical advice and “hands on” solutions that were highly desired elements of support. We have identified directives for future research and practical suggestions for enhancing the setup of link workers’ interventions with this group of adults.

Background. Caregivers are crucial in ensuring that their relatives with heart failure (HF) reach proper self-care levels. Despite this, the demanding nature of caring for others can lead to poor outcomes and the compromise of own needs, which raises the need for perceived social support. Prior research does not offer a thorough knowledge of how caregivers of people with HF regarded social support and the characteristics that went along with it. Purpose. The aim of this study was to develop a comprehensive understanding of perceived social support and its associated factors among caregivers of individuals with heart failure. Methods. This is a secondary analysis of a convergent mixed-methods design study. The perception of social support, mutuality, anxiety, depression, and quality of life were assessed in 158 heart failure patients and their caregivers (physical and mental dimensions). In 50 caregivers, we also performed semistructured interviews. Results. The mixed analysis and integration of qualitative and quantitative inferences revealed two main factors affecting perceived social support. First, caregivers with strong familial network and greater number of caregivers available for tangible caregiving support and moral support perceived increased sense of social support. Second, caregivers with enhanced mental health had increased sense of social support. Conclusions. Caregiver perception of social support might be influenced by mental well-being status. To improve caregivers’ perceptions of social support and community belonging, it is necessary to create and assess community- and individual-based mental health promotion interventions. To strengthen the perception of support in the heart failure caring process, more dyadic strategies should be established to improve patient-caregiver mutuality.

Responsibility for health and care services for people with dementia is often divided between various professionals, agencies, and authorities, causing a fragmentation of care and an unclear division of responsibility between different stakeholders. In relation to this, collaboration and coordination of health and care services are often described as vital for catering to diverse needs and to provide adequate support. The aim of this scoping review was to map how different health and care agencies collaborate and coordinate services for older people with dementia. Joanna Briggs Institute’s proposed methodology for scoping reviews was used, and systematic searches were carried out in six databases. A total of 59 articles published within the last 10 years were included based on certain eligibility criteria. The Research Pyramid was used to critically appraise these articles, suggesting that available research is of moderate quality. The descriptive content analysis of the articles revealed eight categories describing the characteristics of collaboration and coordination for people with dementia, as presented in previous articles. These characteristics are described in terms of different barriers, the function of the care coordinator, assessment and planning to provide services, interprofessional collaboration, information sharing, knowledge needed to navigate a complex health and care system and understanding of dementia, and personalisation of care. Engaging care coordinators with diverse competencies to address both medical and social care needs is essential, especially since people with dementia experience multiple and complex needs. It is also important to explain and visualise available services and when these services are suitable for implementation. Knowledge about dementia is necessary to empower people with dementia in everyday life situations.

Objective. This study aimed to explore the influencing factors to the practice of cardiovascular disease (CVD) preventive behaviors among rural residents based on socio-ecological model (SEM). Methods. We used a mixed-methods research using the sequential explanatory design. From a total of 109 participants, quantitative data including CVD preventive behavior, self-efficacy, social support, and sense of community were collected using previously developed measurement tools. For quantitative research, descriptive statistics and Pearson correlation analysis were conducted. For quantitative research, descriptive statistics and Pearson correlation analysis were conducted. Questions for qualitative research were constructed based on SEM for the three subareas identified in quantitative research. Qualitative content analysis was conducted on qualitative data collected through focus group interviews from 14 participants. Results. According to quantitative research results, participants had a low level of practice in physical exercise, stress management, and self-checking among seven subdomains. At the individual level, self-efficacy was positively correlated with sleep management, and at the interpersonal level, family support was positively correlated with smoking cessation and support from significant others was positively correlated with stress management. On the other hand, at the community level, sense of community did not show significant correlation with the practice of cardiovascular disease prevention. Next, according to qualitative research results, 8 themes were identified in three levels as obstacles. At the personal level, overwork, loneliness, and lack of knowledge about CVD; at the interpersonal and community level, decreased activities with residents due to increased individualistic tendencies and decreased sense of community; and at the community environmental level, inconvenience of sidewalks, lack of community space, and insufficient functioning of village health clinics. Conclusion. In order to reduce obstacles to health behavior practice to prevent cardiovascular disease, multidimensional efforts are needed in terms of socio-ecological aspects.

The aim of this study was to give a voice to people from asylum seeker and refugee backgrounds in Australia during the COVID-19 pandemic and to explore their perspectives concerning their experiences of everyday life. The findings highlight the impacts the pandemic had on these groups, how it exacerbated existing vulnerabilities, worsened mental health, increased social isolation, affirmed a sense of abandonment, and heightened financial precarity. The study adhered to a social constructivist approach. It used a qualitative methodology guided by a narrative research approach. Semistructured in-depth interviews with thirteen participants were thematically analyzed to generate a global theme and subthemes. For people from asylum seeker and refugee backgrounds in Australia, the government-mandated lockdown measures led to increased feelings of loneliness and loss of social support networks, reduced access to public spaces, and limited engagement in face-to-face activities and opportunities for socializing and maintaining mental well-being. The pandemic intensified domestic partner violence incidents and financial stress emerged as a major concern. Participants lost or had reduced employment, and many were ineligible for government financial support. These challenges intersected with preexisting hardships which contributed to feelings of abandonment. Based on the findings, implications include the need for inclusive policies and targeted healthcare support, measures to prevent and respond to partner violence, and inclusive financial assistance schemes that address the unique needs of people from asylum seeker and refugee backgrounds in Australia. Further research is needed to inform therapeutic supports and trauma-informed services for these groups.

Most long-term care systems (social care) for older people rely on some means testing, copayment system, private insurance, or other non-governmental funding to supplement state provision. In England, an estimated quarter of homecare delivery is funded privately. For many older people, the absence of state funding for their care is only part of the problem: they are also expected to search for care in a market characterised by complexity, plurality, and imperfect information. Surprisingly, there are few services available to support private funders to navigate the system. This paper examines willingness to pay for care navigation and seeks to classify heterogeneity of preferences for navigation support. A discrete choice experiment (DCE) survey was completed by 182 participants across England in 2020-21. The results of the random parameter logit model used to analyse preferences showed that people valued information about care options (quality, information, and finances), but they also wanted help to “think things through,” as processing information could be challenging. Generally, participants valued what the navigation service provided, more than how the services were organised and delivered. The study also used latent class analysis to identify four groups with similar preferences, with almost half of participants (48%) expressing high willingness to pay for a comprehensive navigation service. The other three classes represented those with preferences focused on a narrower set of attributes: fast access to information (20%), affordable help to “think things through” (18%), and information provided by their local council (14%). The study demonstrates the potential demand and likely take-up of navigation support if made available to people who pay privately for care. Future research needs to examine the barriers to market development for social care navigation services.