Evidence and Policy
The Background to the PMS 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 (after 2 years of planning and a Community Consultation in partnership with Mid Devon District Council): 9-month Pilot Project, with 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 service model. Questionnaires were piloted for acceptability and individual sensitivity, leading to selection of outcome measures for the following research stages. Pilot Report 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, staff, strategic partners) used to improve Upstream’s delivery processes. Participants could still benefit from the 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 /community participation also seems to be an important cross-cutting theme. For example, those who perceived they were helping others seem to benefit particularly.
