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Background The health and wellbeing consequences of social determinants of health and health behaviours are well established. This has led to a growing interest in social prescribing, which involves linking people to services and supports in the community and voluntary sectors to address non-medical needs. However, there is considerable variability in approaches to social prescribing with little guidance on how social prescribing could be developed to reflect local health systems and needs. The purpose of this scoping review was to describe the types of social prescribing models used to address non-medical needs to inform co-design and decision-making for social prescribing program developers. Methods We searched Ovid MEDLINE(R), CINAHL, Web of Science, Scopus, National Institute for Health Research Clinical Research Network, Cochrane Central Register of Controlled Trials, WHO International Clinical Trial Registry Platform, and ProQuest – Dissertations and Theses for articles and grey literature describing social prescribing programs. Reference lists of literature reviews were also searched. The searches were conducted on 2 August 2021 and yielded 5383 results following removal of duplicates. Results 148 documents describing 159 social prescribing programs were included in the review. We describe the contexts in which the programs were delivered, the program target groups and services/supports to which participants were referred, the staff involved in the programs, program funding, and the use of digital systems. Conclusions There is significant variability in social prescribing approaches internationally. Social prescribing programs can be summarised as including six planning stages and six program processes. We provide guidance for decision-makers regarding what to consider when designing social prescribing programs.

Background For the majority of serving members, life in the military has a positive effect on wellbeing. However, the type, intensity and duration of service, along with the transition from fulltime military to civilian life, may have a negative effect on veterans’ wellbeing. Such negative consequences, alongside the growing veteran population, indicate the need for greater exploration of veterans’ physical, mental and social wellbeing. Methods The current paper reports on the findings of a rapid review of the literature on the health and wellbeing needs of veterans, commissioned by the Australian Department of Veterans’ Affairs to inform future programs and services. The databases Embase, Medline, Cinahl, PubMed, Web of Science and Cochrane Database were searched for systematic reviews reporting on veterans’ physical, mental and social wellbeing published in English in peer-reviewed journals. Results A total of 21 systematic reviews were included. The reviews reported on a range of mental, physical and social health problems affecting veterans. While there was limited information on prevalence rates of physical, mental and social health problems in veterans compared to civilian populations, the reviews demonstrated the interconnection between these domains and the effect of demographic and military service factors. Conclusions A key finding of the review is the interconnection of the mental, physical, and social health of veterans, highlighting the importance that an integrated approach to veterans’ wellbeing is adopted. It is suggested that understanding key factors, such as demographic factors and factors relating to military service, can support improved service provision for veterans.

Background There is growing interest in the use of routine outcome measures (ROM) in mental health services worldwide. Australia has been at the forefront of introducing ROM in public mental health services, with the aim of improving services and consumer outcomes. Methods An in-depth policy and document analysis was conducted using Carol Bacchi’s ‘What is the problem represented to be?’ approach to critically analyse the use of ROM. This approach was used to identify and analyse the problem representations relating to the need for, and the choice of, outcome measures in Australian public mental health services, and the potential consequences of policy and practice. Data included in the analysis were seven policy documents, four reports on the introduction of outcome measures in Australia, the Australian Mental Health Outcomes and Classifications Network website, and the content of the outcome measures themselves. Results Two dominant representations of the ‘problem’ were identified: 1) the ‘problem’ of mental health service quality and accountability, relating to the need for mental health outcome measures; and 2) the ‘problem’ of addressing deficits in biopsychosocial functioning of mental health consumers, which relates to the choice of outcome measures. Framing the ‘problem’ of mental health outcomes in these ways locates the problem within individual health providers, services, and consumers, ignoring the broader socioeconomic conditions underpinning mental health and effective service provision. Conclusions This critical analysis of the introduction and use of ROM in public mental health services in Australia highlights the need to consider the role of the social determinants of mental health, mental health service funding, and recovery-oriented care in ensuring services are meeting consumer needs and expectations. Broader governmental engagement is central to genuine change and opportunities.

Introduction Restrictive practice use in residential aged care homes internationally is unacceptably high. Although policies and legislation mandate the reduction or elimination of restrictive practices, there remains a gap in knowledge regarding strategies that have been effective in achieving a sustained reduction in restraint use. There is an urgent need to identify effective and feasible interventions that aged care staff can implement in everyday practice to reduce restraint use. Safewards is an evidence‐based programme that has demonstrated effectiveness in reducing conflict and restrictive practice use in inpatient psychiatric settings and has the potential to address the issue of restraint use in aged care homes. This study aims to evaluate the feasibility of Safewards in reducing restrictive practices in residential aged care homes. Methods This pilot and feasibility study will adopt a mixed methods process and outcomes evaluation. Safewards will be implemented in two Australian residential aged care homes. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will be used to evaluate implementation outcomes. Additionally, the Consolidated Framework for Implementation Research will be used to guide qualitative data collection (including semi‐structured interviews with residents/family members, aged care leaders and staff) and explain the facilitators and barriers to effective implementation. Conclusion This study will provide pilot evidence on the feasibility of the Safewards programme in residential aged care homes. Understanding the processes and adaptations for implementing and evaluating Safewards in residential aged care will inform a future trial in aged care to assess its effectiveness. More broadly, the findings will support the implementation of an international aged care policy of reducing restrictive practices in residential aged care. Patient or Public Contribution A person with lived experience of caring for someone with dementia is employed as a Safewards facilitator and is a member of the steering committee. Residents and family members will be invited to participate in the project steering committee and provide feedback on their experience of Safewards. Trial Registration ACTRN12624000044527.

Background Process evaluations are considered an essential component in conducting and reporting complex interventions, such as those studied in randomised controlled trials (RCTs) of implementation interventions, to explain the effect of implementation interventions. Given the growth of RCTs of implementation interventions with embedded process evaluations, it is timely to review the explanatory learnings to date. This scoping review explores process evaluations of RCTs of implementation interventions to examine how studies are conducted and what insights can be offered about how and why implementation interventions achieve (or not) their intended impacts. Methods The scoping review was conducted in accordance with the JBI methodology. MEDLINE, CINAHL, Scopus, Web of Science and PsycINFO were searched. Articles were screened and data were extracted by two independent reviewers. Results Of the 5857 studies screened, 81 process evaluations were included. Two process evaluations reported on the same trial, resulting in a final number of n  = 80 independent studies. Half of studies (48%) reported on implementation trials with no demonstrated effect on the primary outcome (null), while n  = 32 (40%) reported on trials where the intervention group demonstrated positive changes in the primary outcome (positive). Seven studies (9%) had mixed findings and n  = 3 (4%) studies had no reported trial outcomes. When comparing process evaluation findings from positive and null trials, few discernible patterns that clearly explained the difference in outcomes were identified. Education and training was the most common strategy used in implementation interventions, yet one of the most common implementation barriers reported related to knowledge and self-efficacy, which could indicate a misalignment. Availability of resources was the most prominent barrier for both positive and null trials and there was little evidence that implementation interventions were tailored to context despite prominent barriers and enablers at the inner and outer setting level. Conclusions Process evaluation studies embedded in RCTs of implementation interventions are recommended as an important method to explain whether and how interventions produce their intended effect. This review suggests a need to further optimise the design and evaluation of implementation interventions, including the conduct and reporting of process evaluations, to continue advancing the science and practice of implementation. Trial registration Protocol published in Open Science Framework, May 10 2022 (Collyer et al., Process evaluations in randomised trials of implementation interventions in health care: a scoping review protocol. In Open science framework, 2022).

Background Many people with mental illnesses remain isolated, chained, and inside cages, called Pasung in Indonesia. Despite numerous policies introduced to eradicate Pasung, Indonesia has made slow progress in decreasing this practice. This policy analysis examined existing policies, plans and initiatives in Indonesia targeted at eradicating Pasung. Policy gaps and contextual constraints are identified in order to propose stronger policy solutions. Methods Eighteen policy documents were examined, including government news releases and organisational archives. A content analysis was undertaken of national-level policies that address Pasung within the context of the health system, social system and human rights since the establishment of Indonesia. This was followed by a case study analysis of policy and program responses particularly in West Java Province. Findings While policy to address Pasung exists at a national level, implementation at national and local levels is complicated. Pasung policy has generated a sense of awareness but the different directions and ambiguous messaging across all stakeholders, including policy actors, has created a lack of clarity about institutions’ roles and responsibilities in the implementation process, as well as accountability for outcomes. This situation is exacerbated by an incomplete decentralisation of healthcare policymaking and service delivery, particularly at the primary level. It is possible that policymakers have overlooked international obligations and lessons learned from successful policymaking in comparable regional countries, resulting in disparities in target-setting, implementation mechanisms, and evaluation. Conclusion While the public has become more informed of the need to eradicate Pasung, ongoing communication with the various clusters of policy actors on the aforementioned issues will be critical. Addressing the various segments of the policy actors and their challenges in response to policy will be critical as part of building the evidence base to establish a feasible and effective policy to combat Pasung in Indonesia.

Introduction Social needs such as housing, employment, food, income and social isolation are having a significant impact on individuals, families and communities. Individuals are increasingly presenting to health settings with social needs, which are ill‐equipped to address nonmedical needs. Social prescribing is a systematic approach connecting the health, social and community sectors to better address social needs and improve health and wellbeing. Social prescribing interventions are being implemented world‐wide. With variability in health and social care systems internationally, it is important that social prescribing interventions are co‐designed with key stakeholders to ensure they can be implemented and sustained within local systems. Methods This Australian case study provides a detailed description of the process undertaken to co‐design a social prescribing service model in a regional area. Four co‐design workshops were undertaken, two with health and social care professionals and two with community members. The project followed an iterative process of resourcing, planning, recruiting, sensitising, facilitation, reflection and building for change across the workshops. Results Through this process, key stakeholders were able to successfully co‐design a social prescribing model of care for the region. Conclusion By demonstrating the process and materials used in our project, we aim to open the ‘black box’ of co‐design for social prescribing and provide ideas and resources for others to adapt and utilise. Patient or Public Contribution The project was designed and undertaken by a steering committee comprising university‐based researchers (authors C. O. and S. B.), local government (author D. A.) and health, social and community services (authors B. G., M. W., J. O. and S. R.). Members of the steering committee participated in project design, participant recruitment, workshop facilitation, data analysis and interpretation.

Background Pasung is the term used in Indonesia and a number of other countries for seclusion and restraint of people with mental illness in the community, usually at home by their family. While pasung has been banned because it is contrary to human rights, its practice continues to exist within the community, particularly where community mental health services are limited, and in the absence of adequate social support, and pervasive negatives beliefs about mental illness. It is essential to understand the reasons for the ongoing use of pasung and to examine potential solutions. Methods A systematic review and narrative synthesis of peer-reviewed international literature was conducted to identify the socio-cultural contexts for pasung use, and interventions to address it. The analysis draws on the socio-ecological framework, which focused on relationships between the individual and their environment. Result Fifty published articles were included in the review; all studies were conducted in Asia and Africa, with 32 undertaken in Indonesia. Most studies were qualitative (n = 21). Others included one case–control study, one cross-sectional study, and seven surveys; only four studies examined the application of an intervention, and each used a pre and post methodology. Of these, two studies tested psychoeducational interventions which aimed to overcome family burden due to pasung, and each suggested a community mental health approach. The remaining two studies evaluated the intervention of ‘unlocking’; one study used a community-based culturally sensitive approach, and the other used a community-based rehabilitation program. Reasons for pasung given by family appear to be as a last resort and in the absence of other supports to help them care for the person with severe mental illness. Conclusion The findings highlight that a mixture of individual, interpersonal, community and policy interventions are needed to reduce the use of pasung. While consumer and carer involvement as part of a socio-ecological approach is understood to be effective in reducing pasung, an understanding of how to elaborate this in the management of pasung remains elusive. Review Registration CRD42020157543: CRD

Background Social needs - such as housing, income, food security, and social connectedness - have a significant effect on health and wellbeing. One way to address social needs is through social prescribing, which involves screening for unmet needs (e.g., during healthcare appointments) and providing referrals to social and community services. For social prescribing to be effective, it must address both individual needs as well as support the social and community services that are required to meet these needs. The objective of this study is to adopt a place-based framework that combines: (1) individual-level referral for social needs, with (2) community and stakeholder engagement to determine community assets, resources, networks, and need to inform model development. Methods The study will be conducted in three-phases across two low-socioeconomic Australian communities, underpinned by the ‘enabling places’ theoretical framework. Phase 1 will involve identifying key elements that enable place-based social prescribing using photovoice methods with health and social care providers and community members. Outcomes will inform co-design workshops to develop a place-based social prescribing model of care that is augmented by technology to facilitate integration across health, social, and community services. In Phase 2, the co-designed model will be implemented in the two communities. Phase 3 will involve a mixed methods approach to the evaluation of the model’s implementation, effectiveness, and social return on investment. Discussion The study aims to foster place-based initiatives and community development, a missing element in much of the social prescribing discourse. It is anticipated that outcomes will contribute to the design and implementation of social prescribing models that are tailor-made for Australian communities, systems, and funding systems.

Background Older people are living longer with unmet social needs that impact their health and wellbeing. Social prescribing programs connect individuals with nonclinical services to address these needs. While international programs have shown benefits for quality of life, health and healthcare utilisation, social prescribing research in Australia is limited. Objective This study aims to design, implement and evaluate a social prescribing program to address the unmet social needs of older adults in Adelaide, South Australia. Research Design and Methods This observational feasibility study will use a multiphase mixed methods process and outcomes evaluation. Prescriptions for Connection, a social prescribing program, will be co‐designed and implemented in six primary care practices and three council areas. Implementation outcomes will be evaluated using the Reach, Effectiveness, Adoption, Implementation and Maintenance Framework. Qualitative data collection, via focus groups for health and social care providers and interviews for older people, will be based on the Consolidated Framework for Implementation Research to explore barriers and facilitators, and explain outcomes. Conclusion This study will provide novel evidence on the process, outcomes and feasibility of the Prescriptions for Connection program. Scalability, sustainability and modifications to the program will be explored for testing in a larger hybrid effectiveness‐implementation trial. Patient or Public Contribution Older adults will participate in codesign workshops and provide feedback on the Prescriptions for Connection program. Community members will be recruited as volunteer community connectors to link older people to social activities. The national peak body for older Australians will be represented on the steering group. Trial Registration: ACTRN12625000664448.