The Well London program - a cluster randomized trial of community engagement for improving health behaviors and mental wellbeing: baseline survey results

Background The Well London programme used community engagement, complemented by changes to the physical and social neighbourhood environment, to improve physical activity levels, healthy eating and mental wellbeing in the most deprived communities in London. The effectiveness of Well London is being evaluated in a pair-matched cluster randomised trial (CRT). The baseline survey data are reported here. Methods The CRT involved 20 matched pairs of intervention and control communities (defined as UK census lower super output areas; ranked in the 11% most deprived LSOAs in London by Index of Multiple Deprivation) across 20 London boroughs. The primary trial outcomes, sociodemographic information and environmental neighbourhood characteristics were assessed in three quantitative components within the Well London CRT at baseline: a cross-sectional, interviewer-administered adult household survey; a self-completed, school-based adolescent questionnaire; a fieldworker completed neighbourhood environmental audit. Baseline data collection occurred in 2008. Physical activity, healthy eating and mental wellbeing were assessed using standardised, validated questionnaire tools. Multiple imputation was used to account for missing data in the outcomes and other variables in the adult and adolescent surveys. Results There were 4107 adults and 1214 adolescent respondents in the baseline surveys. The intervention and control areas were broadly comparable with respect to the primary outcomes and key sociodemographic characteristics. The environmental characteristics of the intervention and control neighbourhoods were broadly similar. There was greater between cluster variation in the primary outcomes in the adult population compared to the adolescent population. Levels of healthy eating, smoking and self-reported anxiety/depression were similar in the Well London population and the national Health Survey for England. Levels of physical activity were higher in the Well London population but this is likely to be due to the different measurement tools used in the two surveys. Conclusions Randomisation of social interventions such as Well London is acceptable and feasible and in this study the intervention and control arms are well balanced with respect to the primary outcomes and key sociodemographic characteristics. The matched design has improved the statistical efficiency of the study amongst adults but less so amongst adolescents. Follow-up data collection will be completed 2012.

In Protection of Whose “Wellbeing”? Considerations of “Clauses and A/Effects” in Athlete Contracts

Contractual agreements have become an accepted part of participation processes for athletes in a variety of sport contexts. Closer readings of these contracts,however, pose several questions regarding organizational intentions and motivations,the conceptualization of athletes as “workers,” and representation parity. In this article, we draw on four types of athlete contractual documents from both select international “amateur” and “professional” sport settings. Our key considerations include athletes’ ownership over their image and identities; medical and health disclosures; lifestyle, behavioral and body choices, and restrictions beyond sport; adherence to organizational philosophy and commitments; and social media and publicity constraints. Our exegesis here encourages sport researchers to deliberate whose “wellbeing” matters most when signing that seductive dotted line.

Improving health and wellbeing independently of GDP: dividends of greener and prosoical economies

Increases in gross domestic product (GDP) beyond a threshold of basic needs do not lead to further increases in well-being. An explanation is that material consumption (MC) also results in negative health externalities. We assess how these externalities influence six factors critical for well-being: (i) healthy food; (ii) active body; (iii) healthy mind; (iv) community links; (v) contact with nature; and (vi) attachment to possessions. If environmentally sustainable consumption (ESC) were increasingly substituted for MC, thus improving well-being and stocks of natural and social capital, and sustainable behaviours involving non-material consumption (SBs-NMC) became more prevalent, then well-being would increase regardless of levels of GDP. In the UK, the individualised annual health costs of negative consumption externalities (NCEs) currently amount to £62 billion for the National Health Service, and £184 billion for the economy (for mental ill-health, dementia, obesity, physical inactivity, diabetes, loneliness and cardiovascular disease). A dividend is available if substitution by ESC and SBs-NMC could limit the prevalence of these conditions.

A Healthier Future: A Twenty Year Vision for Health and Wellbeing in Northern Ireland 2005-2025

This Regional Strategy, A Healthier Future, aims to provide a vision of how our health and social services will develop and function over the next 20 years. In order to succeed, it must embrace the measures needed to promote health and wellbeing, support, protect and care for the most vulnerable and facilitate the delivery of services.

Pratiques associatives et construction d'un espace social citoyen à Trou du Nord (Haïti)

Ce mémoire traite de la construction d’un espace social citoyen à partir de l’analyse du travail d’intervention de deux organismes locaux situés à Trou du Nord (Haïti). Il s’agit d’explorer les manières dont les membres se représentent et s’approprient leur statut de citoyen. Pour mettre l’emphase sur les mécanismes associatifs et sociaux qui interviennent dans la construction de ce que nous nommons "espace social citoyen", nous avons mené une recherche qualitative dont la charpente interprétative est conçue avec l’aide des outils théorico-pratiques de la politique de participation (Barber, 1997) et l’intervention sociale collective (Lamoureux, 1991). Nous avançons l’hypothèse centrale que les pratiques associatives sont le vecteur de la construction d’un espace social citoyen à Trou du Nord. Cette hypothèse centrale est soutenue par deux hypothèses opératoires portant sur les conditions d’exercice de citoyenneté et l’affirmation individuelle de l’appartenance des membres à l’espace commun. Nous avons recueilli quatorze entretiens semi-directifs effectués avec les membres de l’Assemblée Populaire Veye Yo Trou du Nord (APVT) et du Rassemblement des Militants Solidaires de Trou du Nord (RAMSO). Les résultats de la recherche indiquent que les membres de ces deux organisations manifestent une grande volonté de contribuer au développement de leur localité et au «mieux-être» de la population. Leur implication directe dans les affaires politiques et sociales s’accompagne des exigences pour que l’État prenne en charge ses responsabilités vis-à-vis de ses citoyens. Cette liberté d’action repose sur le partage de leurs expériences individuelles et sur une grande connaissance des divers aspects des réalités locales auxquelles sont confrontés quotidiennement les citoyens. Ces deux groupes sont conçus comme des espaces de sociabilité, des lieux publics et dynamiques issus de l’activité commune et des divers types d’interactions au niveau local. Toujours d’après l’analyse, les membres de ces deux groupes interviennent sur un problème d’ensemble collectif au niveau local sans pour autant négliger leurs propres intérêts. Ils s’inscrivent dans le jeu de marchandage électoral et apprennent à leurs membres à se comporter comme une communauté d’intérêts et d’actions, elle-même inscrite dans l’ensemble des interactions, des processus et des dynamiques de résolution des problèmes au niveau local. Un tel constat vient à la fois valider certaines de nos hypothèses tout en révélant les limites de l’idée de la construction d’un espace social citoyen. D’une part, la volonté de contribuer au «mieux-être» de la population, la nécessité de prendre la parole, d’exprimer les problèmes collectifs et individuels, le souci d’avoir un contrôle sur l’action des dirigeants élus sont autant d’enjeux qui leur ont permis de passer de leur vécu particulier à une vision plus large des intérêts collectifs et à la définition des tâches qu’ils estiment correspondre au rôle citoyen qui leur incombe. D’autre part, leur positionnement dans le champ politique notamment au moment des élections les fait apparaître comme des groupes partisans, c'est-à-dire qu’ils ne sont pas toujours dans la construction de l’intérêt général. Nous concluons que ce double aspect s’avère nécessaire aussi bien à la construction de l’espace social citoyen qu’au fonctionnement démocratique au niveau local. Car, en plus de se définir comme citoyens et d’affirmer leur appartenance communautaire, les membres développent les capacités critiques face aux gestes et actes posés autant par les dirigeants locaux que par l’État haïtien lui-même. Ils acquièrent aussi les habilités de participer, même dans les interstices, aux jeux sociopolitiques faisant partie du processus de renforcement de la citoyenneté et d’un système démocratique en construction.

On the health and wellbeing of single working women without children : an analysis of scientific and lay discourse

Cette thèse examine la façon dont on interprète la santé et le bien-être des travailleuses célibataires et sans enfant au sein de deux types de récits : ceux provenant d’études publiées dans des périodiques (récits scientifiques) et ceux provenant d’entrevues qualitatives avec des membres de ce groupe (récits profanes). Sur le plan démographique, leur nombre est significatif; elles représentent 28% des employées canadiennes. Par contre, leur santé/bien-être est peu visible dans les écrits de recherche. Dans les sciences sociales, plusieurs études portent sur l’expérience parfois éprouvante d’être un adulte célibataire vivant dans une culture orientée sur le couple et la famille. Elles mettent l’accent sur le stigma associé à ce statut. Certains suggèrent même que les pratiques de recherche peuvent contribuer à la perpétuation de représentations négatives à l’égard des célibataires. En ayant un profil qui pourrait être symbolique d’une déviation vis-à-vis des attentes normatives entourant la vie de couple ou de famille, les travailleuses célibataires et sans enfant semblent un point de repère utile pour évaluer cette dernière possibilité. S’attarder autant aux récits scientifiques que profanes permettrait d’explorer les tensions et convergences entre eux. Suivant cet objectif, un échantillon de 32 articles scientifiques et de 22 retranscriptions d’entrevues ont été analysés selon une approche d’analyse de discours guidée par les concepts de répertoire interprétatif (une façon cohérente d’aborder un sujet donné) et de position du sujet (une identité mise en évidence par une façon de parler ou d’écrire). Trois articles ont émergé de cette recherche. Suite à une analyse des thèmes communs utilisés dans l’interprétation de la santé/du bien-être du groupe en question, un répertoire interprétatif surnommé la famille comme référence a été identifié. Ce répertoire expliquerait notamment la tendance observée d’expliquer leur santé/bien-être en référant aux états et aux charactéristiques d’être parent ou partenaire. Cette pratique peut avoir l’effet de voiler leur vie privée ou de la construire comme étant relativement appauvrie. L’article 2 examine comment les membres de ce groupe construisent leur propre bien-être. Il identifie la notion d’équilibre entre plusieurs sphères de vie et une identité de femme dynamique comme éléments centraux aux récits sur leur bien-être. Ces derniers vont à l’encontre de la perception des célibataires ou des personnes sans enfant comme ayant des vies moins épanouies ou enrichies et qui ne sont pas touchées par des questions de conciliation travail-vie personnelle. Le troisième article rassemble les deux types de récits autour des sujets de l’emploi et du statut de célibataire en lien avec le bien-être. Il met en évidence de nombreuses similarités et divergences, et théorise la fonction de ces diverses constructions. En conclusion, j’avance qu’une perspective plus critique face au statut de couple ou familial et de ses aspects normatifs pourrait offrir à la recherche en santé publique un point de réflexivité à développer davantage.

Occupational therapy and its relevance in social projects. relationships, learning and opportunities: collection of experiences of University of Alberta Mscot students in Bogotá, Colombia

Occupational therapists are equipped to promote wellbeing through occupation and to enable participation and meaningful engagement of people in their social and physical environments (WFOT, 2012). As such, the role of the occupational therapists is profoundly linked to the social, cultural and environmental characteristics of the contexts in which occupations take place. The central role that context plays in occupational performance creates an interesting dichotomy for the occupational therapist: on one hand, a profound understanding of cultural and social factors is required from the Occupational Therapy (OT) in order to develop a meaningful and successful collaboration with the person; on the other hand, the ability of the occupational therapists to recognize and explore the contextual factor of an occupation-person dyad transcends cultural and spatial barriers. As a result, occupational therapists are equipped to engage in international collaboration and practice, and as such face unique and enriching challenges. International fieldwork experiences have become a tool through which occupational therapists in training can develop the critical skills for understanding the impact of cultural and social factors on occupation. An OT student in an international fieldwork experience faces numerous challenges in leading a process that is both relevant and respectful to the characteristics of the local context: language, cultural perceptions of occupation and personhood, religious backgrounds, health care access, etc. These challenges stand out as ethical considerations that must be considered when navigating an international fieldwork experience (AOTA, 2009). For more than five years now, the Faculty of Rehabilitation Medicine (FRM) of the University of Alberta (UoFA) and the School of Medicine and Health Sciences at the Universidad del Rosario (UR), Bogota, Colombia, have sustained a productive and meaningful international collaboration. This collaboration includes a visit by Dr. Albert Cook, professor of the FRM and former dean, to the UR as the main guest speaker in the International Congress of Technologies for Disability Support (IBERDISCAP) in 2008. Furthermore, Dr. Cook was a speaker in the research seminar of the Assistive Technology Research Group of the Universidad del Rosario. Following Dr. Cook’s visit, Professors Liliana Álvarez and Adriana Ríos travelled to Edmonton and initiated collaboration with the FRM, resulting in the signing of an agreement between the FRM and the UR in 2009, agreement that has been maintained to this day. The main goal of this agreement is to increase academic and cultural cooperation between the UR and the UofA. Other activities have included the cooperation between Dr. Kim Adams (who has largely maintained interest and effort in supporting the capacity building of the UR rehabilitation programs in coordinating the provision of research placement opportunities for UR students at the UofA), an Assistive Technology course for clinicians and students led by Dr. Adams, and a research project that researched the use of basic cell phones to provide social interaction and health information access for people with disabilities in a low-income community in Colombia (led by Tim Barlott, OT, MSc, under the supervision of Dr. Adams). Since the beginning, the occupational therapy programs of the Universidad del Rosario and the University of Alberta have promoted this collaboration and have strived to engage in interactions that provide further development opportunities for students and staff. As part of this process, the international placement experience of UofA OT students was born under the leadership of: Claudia Rozo, OT program director at UR, placement and academic leadership of Elvis Castro and Angélica Monsalve, professors of the occupational therapy program at UR; and Dr. Lili Liu, OT department director at UofA, Cori Schmitz, Academic coordinator of clinical education at the UofA; and Tim Barlott and Liliana Álvarez leading the international and cross-cultural aspect of this collaboration.This publication summarizes and illustrates the process of international placement in community settings in Colombia, undertaken by occupational therapy students of the University of Alberta. It is our hope that this document can provide and document the ethical considerations of international fieldwork experience, the special characteristics of communities and the ways in which cultural and social competences are developed and help international students navigate the international setting. We also hope that this document will stimulate discussion among professional and academic communities about the importance and richness of international placement experiences and encourage staff and students to articulate their daily efforts with the global occupational therapy agenda.

Värdigt liv och välbefinnande, enligt vem? : en kvalitativ studie om brukare och biståndshandläggares beskrivningar av ett värdigt liv och välbefinnande : Dignity and well-being, according to whom? : a qualitative study of elderly and assistance officer´s descriptions of a dignified life and wellbeing

We are two students named Susanne Grönlund and Anna Zaar and have jointly worked together this c-essay called "dignity and well-being according to whom? The paper is written at Högskolan dalarna in Falun.The purpose of this study was to investigate how the elderly and assistance officer describes dignity and well-being and how it is consistent with the government's bill on the national values that the National Board has developed.Our empirical study consists of four qualitative interviews, two older people dependent on community care and two assistance officers. The study's theoretical basis is Antonovsky's salutogenic approach and SOC. The survey focuses on different themes such as dignity, integrity, participation, treatment, wellbeing, security and meaningfulness which are also central themes in the Government Bill on the national values for elderly.The results show that the respondents believe that a life of dignity is difficult to define and also a subjective experience. The results also show a consistency between what the elderly, assistance officer and the national values that define dignity and well-being. Social Services Act, national values should serve as a starting point for municipalities to improve elderly care, thereby creating a sense of coherence for the individual. Keywords: Elder care, dignity, integrity, participation, attitude, well-being, security and meaningfulness.

'Moving On' and Transitional Bridges : Studies on migration, violence and wellbeing in encounters with Somali-born women and the maternity health care in Sweden

During the latest decade Somali-born women with experiences of long-lasting war followed by migration have increasingly encountered Swedish maternity care, where antenatal care midwives are assigned to ask questions about exposure to violence. The overall aim in this thesis was to gain deeper understanding of Somali-born women’s wellbeing and needs during the parallel transitions of migration to Sweden and childbearing, focusing on maternity healthcare encounters and violence. Data were obtained from medical records (paper I), qualitative interviews with Somali-born women (II, III) and Swedish antenatal care midwives (IV). Descriptive statistics and thematic analysis were used. Compared to pregnancies of Swedish-born women, Somali-born women’s pregnancies demonstrated later booking and less visits to antenatal care, more maternal morbidity but less psychiatric treatment, less medical pain relief during delivery and more emergency caesarean sections and small-for-gestational-age infants (I). Political violence with broken societal structures before migration contributed to up-rootedness, limited healthcare and absent state-based support to women subjected to violence, which reinforced reliance on social networks, own endurance and faith in Somalia (II). After migration, sources of wellbeing were a pragmatic “moving-on” approach including faith and motherhood, combined with social coherence. Lawful rights for women were appreciated but could concurrently risk creating power tensions in partner relationships. Generally, the Somali-born women associated the midwife more with providing medical care than with overall wellbeing or concerns about violence, but new societal resources were parallel incorporated with known resources (III). Midwives strived for woman-centered approaches beyond ethnicity and culture in care encounters, with language, social gaps and divergent views on violence as potential barriers in violence inquiry. Somali-born women’s strength and contentment were highlighted, and ongoing violence seldom encountered according to the midwives experiences (IV). Pragmatism including “moving on” combined with support from family and social networks, indicate capability to cope with violence and migration-related stress. However, this must be balanced against potential unspoken needs at individual level in care encounters.With trustful relationships, optimized interaction and networking with local Somali communities and across professions, the antenatal midwife can have a “bridging-function” in balancing between dual societies and contribute to healthy transitions in the new society.

‘Moving on’ : Violence, wellbeing and questions about violence in antenatal care encounters. A qualitative study with Somali-born refugees in Sweden

Background Somali-born women constitute one of the largest groups of childbearing refugee women in Sweden after more than two decades of political violence in Somalia. In Sweden, these women encounter antenatal care that includes routine questions about violence being asked. The aim of the study was to explore how Somali-born women understand and relate to violence and wellbeing during their migration transition and their views on being approached with questions about violence in Swedish antenatal care. Method Qualitative interviews (22) with Somali-born women (17) living in Sweden were conducted and analysed using thematic analysis. Findings A balancing actbetween keeping private life private and the new welfare system was identified, where the midwife's questions about violence were met with hesitance. The midwife was, however, considered a resource for access to support services in the new society. A focus on pragmatic strategies to move on in life, rather than dwelling on potential experiences of violence and related traumas, was prominent. Social networks, spiritual faith and motherhood were crucial for regaining coherence in the aftermath of war. Dialogue and mutual adjustments were identified as strategies used to overcome power tensions in intimate relationships undergoing transition. Conclusions If confidentiality and links between violence and health are explained and clarified during the care encounter, screening for violence can be more beneficial in relation to Somali-born women. The focus on “moving on” and rationality indicates strength and access to alternative resources, but needs to be balanced against risks for hidden needs in care encounters. A care environment with continuity of care and trustful relationships enhances possibilities for the midwife to balance these dual perspectives and identify potential needs. Collaborations between Somali communities, maternity care and social service providers can contribute with support to families in transition and bridge gaps to formal social and care services.

The relationships between migration, social support and social integration on quality of Life

Past research indicates that humans have a remarkable ability to maintain normal levels of subjective wellbeing despite adverse objective circumstances. This suggests that such wellbeing may be held under homeostatic control. This paper investigates some of the potential factors
that may contribute to this homeostatic mechanism, in response to the major life event of migration. Three groups were examined: Persian immigrants to Australia (Persian- Australians), non-Persian Australians, and Persians residing in Iran. A total of 330 subjects were recruited. A notable finding was that all three groups did not differ in regard to subjective wellbeing, despite the Persian-Australians being a minority ethnic group in Australia, and the Persians having significantly lower objective life quality. The Persian-Australians who migrated at an older age reported lower subjective quality of life, while the number of years of residence in Australia did not appear to be related to the extent of social integration. Subjective life quality was, however, related to subjective social support for the Australian and Persian samples, and to reciprocality of support for the Persian-Australians.

Using environmental interventions to create sustainable solutions to problems to health and wellbeing

Recent research by Deakin University, in collaboration with Parks Victoria and its Strategic Partners, indicates that contact with nature may promote human health and wellbeing. International research indicates that simply viewing a natural scene or watching wildlife reduces stress and tension, improves concentration, remedies mental fatigue, boosts immunity, and enhances psychological health. This is aside from any physical health benefits flowing from reduced stress, increased exercise and improved air quality when contact with nature involves activities in natural environments. The literature suggests that interacting with nature through gardening or having a companion animal is also beneficial for health, and where these activities involve contact with other humans, might extend benefits beyond the individual to the community, through enhanced social capital. This paper sets out the potential scope of work flowing from the initial research, in terms of target groups, research foci, intervention strategies, and likely benefits, and reports on progress in establishing a program of Australian,based empirical research. It proposes the establishment of alliances between researchers and practitioners in a range of disciplines (including environmental health) to ensure that the links between contact with nature and human health and wellbeing are explored and expressed in ways that are both beneficial and sustainable.

Developing a national index of subjective wellbeing: the Australian unity wellbeing index

The Australian Unity Wellbeing Index has been designed as a new barometer of Australians' satisfaction with their lives, and life in Australia. It is based on, and develops, the theoretical model of subjective wellbeing homeostasis. The Index comprises two sub-scales of Personal and National Wellbeing. Data were collected through a nationally representative sample of 2,000 people in April/May 2001.Factor analysis confirmed the integrity of the two sub-scales and, confirming empirical expectation, the average level of life satisfaction was 75.5 percent of the scale maximum score. Group comparisons revealed that all age groups maintained their Personal Index score within the normal range. In addition,people in country areas were more satisfied with their personal lives than city-dwellers,but less satisfied about the national situation, and people who had recently experienced a strong positive event evidenced arise in wellbeing, whereas those who had experienced a strong negative event evidenced wellbeing in the low-normal range. It is argued that these data generally support homeostatic theory. However, an unusual result was that females were more satisfied with their own lives than males. A tentative argument is advanced that this may represent a constitutional difference. It is concluded that the Australian Unity Wellbeing Index has potential as a valid, reliable and sensitive instrument to monitor national wellbeing.

The nature of children's social interactions at school

Interpersonal interactions are important for emotional and psychological wellbeing. One attempt to systematically assess social interactions among gifted children was presented by Manor-Bullock et al. (1995) in their Social Interaction Questionnaire (SIQ). However, no psychometric properties of this scale or the nature of the factors that form students' social interactions have been reported. The aim of this study to ascertain the underlying factor structure of students' social interactions on scores on the SIQ and to compare the responses of children attending a regular school to those in Manor-Bullock et al.'s cohort of gifted children. Two independent factors emerged from the data: social/popular and confident/studious with internal reliability of {alpha} = 0.82 and {alpha} = 0.60 respectively. There were no gender differences on these factors in the current data. Chi square analyses revealed concordance between gifted and regular-school children on seven of 16 comparable items. Discussion of the items demonstrating an association is presented. Confirmation of the current factor structure is necessary and a matched comparison with gifted children is recommended.