Psychometric properties of a brief, self-report measure of social inclusion: the F-SIM16

AIMS

A disproportionate number of people with mental ill-health experience social exclusion. Appropriate measurement tools are required to progress opportunities to improve social inclusion. We have developed a novel measure, the Filia Social Inclusion Measure (F-SIM). Here we aimed to present a more concise, easy-to-use form, while retaining its measurement integrity by (i) refining the F-SIM using traditional and contemporary item-reduction techniques; and (ii) testing the psychometric properties of the reduced measure.

METHODS

Five hundred and six participants completed the F-SIM, younger and older groups of people with serious mental illness (including psychosis, mood, anxiety disorders) and same-aged community counterparts. The F-SIM was completed at baseline and 2-week follow-up, alongside other measures (including social inclusion, loneliness). The F-SIM was refined using multidimensional scaling network analysis, confirmatory factor analysis and item response theory. The psychometric evaluation included assessment of dimensionality, internal consistency, test-retest reliability, discriminant ability and construct validity.

RESULTS

The F-SIM was reduced from 135-items to 16; with 4-items in each domain of housing and neighbourhood, finances, employment and education and social participation and relationships. Psychometric properties were sound, including strong internal consistency within domains (all α > 0.85) and excellent overall (α = 0.92). Test-retest reliability was also high (γ = 0.90). Differences between groups were observed; clinical subgroups consistently reported lower levels of social inclusion compared to community counterparts.

CONCLUSIONS

The F-SIM16 is a sound, reliable, brief self-report measure of social inclusion suitable for use in clinical and research settings. It has the potential to evaluate the effectiveness of interventions, and aid in fostering targeted and personalised needs-based care.

Developing and testing the F-SIM, a measure of social inclusion for people with mental illness

Social inclusion is an important contributor to good mental health and greater mental health outcomes for people with psychiatric disorders. A psychometrically-sound measure of social inclusion is required to facilitate progress in this area. The aim here was to report on preliminary findings from a novel, user-friendly measure of social inclusion that comprehensively assesses the construct. Preliminary testing of the Filia Social Inclusion Measure (F-SIM) was conducted with ninety participants (30 consumers; 30 family members/carers; 30 community members). Participants completed the self-report measure and a usability questionnaire. Preliminary findings demonstrated poorer social inclusion for people with mental illness compared to those without, with differences seen in each of five domains (housing and services, social functioning, occupational functioning, finances and health). Differences were also seen regarding family members or carers, with consistently poorer social inclusion than general community members observed. Participants reported the F-SIM as easy to use, and considered it to measure social inclusion well, indicating good face validity. The F-SIM demonstrates an ability to differentiate between groups. Implications for use and suggestions for future research are detailed. Following further psychometric assessment, the F-SIM will have wide applicability in clinical and research settings.

Understanding what it means to be socially included for people with a lived experience of mental illness

AIMS

Social inclusion is increasingly understood to have positive and beneficial implications for the mental health outcomes of people with severe mental illness. The concept is plagued by definitional inconsistencies and a lack of consensus regarding what it means to be socially included, in particular for groups most vulnerable to social exclusion, such as people with mental illness. The aim of this study was to obtain a consensus regarding the key contributors to social inclusion from the perspective of people with and without a lived experience of mental illness (consumers of mental health services, carers, and general community members).

METHODS

Delphi methodology was employed to reach consensus agreement. The Delphi questionnaire was based on a previous review of the literature and consisted of 147 items categorized into 13 domains. It was presented to participants over three rounds. Participants (N = 104) were recruited into three groups (32 consumers, 32 carers of people with a mental illness, and 40 members of the general community - neither consumers nor carers). Retention of participants from Round 1 to Round 3 was 79.8%.

RESULTS

Similarities and differences were observed between the groups. A number of items were very strongly endorsed as key contributors to social inclusion, relating to social participation, social supports, housing, neighbourhood, community involvement, employment and education, health and well-being and service utilization.

CONCLUSION

Findings supported previous work, indicating the importance of having a strong sense of connection with others as well as the importance of safe and stable housing, support services and personal motivation and hope. We obtained a well-rounded perspective among groups regarding the key contributors to social inclusion, with a particular relevance to people living with mental illness. This perspective has significant clinical and research utility.

Measuring social exclusion in healthcare settings: a scoping review

Background

Social exclusion is a concept that has been widely debated in recent years; a particular focus of the discussion has been its significance in relation to health. The meanings of the phrase “social exclusion”, and the closely associated term “social inclusion”, are contested in the literature. Both of these concepts are important in relation to health and the area of primary healthcare in particular. Thus, several tools for the measurement of social exclusion or social inclusion status in health care settings have been developed.

Methods

A scoping review of the peer-reviewed and grey literature was conducted to examine tools developed since 2000 that measure social exclusion or social inclusion. We focused on those measurement tools developed for use with individual patients in healthcare settings. Efforts were made to obtain a copy of each of the original tools, and all relevant background literature. All tools retrieved were compared in tables, and the specific domains that were included in each measure were tabulated.

Results

Twenty-two measurement tools were included in the final scoping review. The majority of these had been specifically developed for the measurement of social inclusion or social exclusion, but a small number were created for the measurement of other closely aligned concepts. The majority of the tools included were constructed for engaging with patients in mental health settings. The tools varied greatly in their design, the scoring systems and the ways they were administered. The domains covered by these tools varied widely and some of the tools were quite narrow in the areas of focus. A review of the definitions of both social inclusion and social exclusion also revealed the variations among the explanations of these complex concepts.

Conclusions

There are several definitions of both social inclusion and social exclusion in use and they differ greatly in scope. While there are many tools that have been developed for measuring these concepts in healthcare settings, these do not have a primary healthcare focus. There is a need for the development of a tool for measuring social inclusion or social exclusion in primary healthcare settings.

Electronic supplementary material

The online version of this article (10.1186/s12939-018-0732-1) contains supplementary material, which is available to authorized users.

An exploratory study of the extent of social inclusion among people with psychosis and psychotic-related conditions

BACKGROUND

Understanding social inclusion among at-risk populations will deepen our understanding of their specific needs.

AIM

This study explored the level of social inclusion among people with psychotic-related conditions using a standardised interview.

METHOD

The Social Inclusion Interview Schedule was used in two research projects. People with psychosis participated in both studies and had been recruited as part of an Irish programme of research on psychotic conditions. Descriptive statistics were used to quantify participants' level of social exclusion.

RESULTS

Data from 71 participants were available, 38 in one cohort and 33 in the other. The smaller cohort had a shorter mean duration of illness. Participants' mean age was 40. The majority lived in the community and were satisfied with their living arrangements. In each cohort, the same two areas of community integration emerged as problematic - having something productive to do and being close to someone in the community. There was a higher level of perceived stigma among the cohort with the longer duration of illness.

DISCUSSION/CONCLUSION

While evidence of social inclusion was found among participants, there were areas of concern particularly with regard to integration into work and social connectedness.

Social Exclusion Index-for Health Surveys (SEI-HS): a prospective nationwide study to extend and validate a multidimensional social exclusion questionnaire

Background

Social exclusion (SE) refers to the inability of certain groups or individuals to fully participate in society. SE is associated with socioeconomic inequalities in health, and its measurement in routine public health monitoring is considered key to designing effective health policies. In an earlier retrospective analysis we demonstrated that in all four major Dutch cities, SE could largely be measured with existing local public health monitoring data. The current prospective study is aimed at constructing and validating an extended national measure for SE that optimally employs available items.

Methods

In 2012, a stratified general population sample of 258,928 Dutch adults completed a version of the Netherlands Public Health Monitor (PHM) questionnaire in which 9 items were added covering aspects of SE that were found to be missing in our previous research. Items were derived from the SCP social exclusion index, a well-constructed 15-item instrument developed by the Netherlands Institute for Social Research (SCP). The dataset was randomly divided into a development sample (N =129,464) and a validation sample (N = 129,464). Canonical correlation analysis was conducted in the development sample. The psychometric properties were studied and compared with those of the original SCP index. All analyses were then replicated in the validation sample.

Results

The analysis yielded a four dimensional index, the Social Exclusion Index for Health Surveys (SEI-HS), containing 8 SCP items and 9 PHM items. The four dimensions: “lack of social participation”, “material deprivation”, “lack of normative integration” and “inadequate access to basic social rights”, were each measured with 3 to 6 items. The SEI-HS showed adequate internal consistency for both the general index and for two of four dimension scales. The internal structure and construct validity of the SEI-HS were satisfactory and similar to the original SCP index. Replication of the SEI-HS in the validation sample confirmed its generalisability.

Conclusion

This study demonstrates that the SEI-HS offers epidemiologists and public health researchers a uniform, reliable, valid and efficient means of assessing social exclusion and its underlying dimensions. The study also provides valuable insights in how to develop embedded measures for public health surveillance.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4175-1) contains supplementary material, which is available to authorized users.

Mapping the Evolving Ideas of Occupational Justice

The values of occupational therapy are grounded in justice, and its origins in activism and advocacy. Enabling individuals to participate in meaningful occupations to enhance health and well-being was the genesis of the profession that answered a call to justice. Occupational science brought focus to understand humans as occupational beings and made justice more visible in the discourse. A systematic mapping review was undertaken to deconstruct how notions of occupational justice (OJ) have been woven in the literature. The ideas of OJ were dominant in 40 out of the 120 articles that met the study’s inclusion criteria. OJ was represented mainly in the context of disadvantaged groups and dissonance in practice. For OJ to influence policy, the focus on the individuals’ experiences of occupational injustices must be seen as transacting with systems and policies that contribute to participation inequities in groups and populations.

From the rhetoric to the real: A critical review of how the concepts of recovery and social inclusion may inform mental health nurse advanced level curricula - The eMenthe project

OBJECTIVES

This critical review addresses the question of how the concepts of recovery and social inclusion may inform mental health nurse education curricula at Master's level in order to bring about significant and positive change to practice.

DESIGN

This is a literature-based critical review incorporating a rapid review. It has been said that if done well, this approach can be highly relevant to health care studies and social interventions, and has substantial claims to be as rigorous and enlightening as other, more conventional approaches to literature (Rolfe, 2008).

DATA SOURCES

In this review, we have accessed contemporary literature directly related to the concepts of recovery and social inclusion in mental health.

REVIEW METHODS

We have firstly surveyed the international literature directly related to the concepts of recovery and social inclusion in mental health and used the concept of emotional intelligence to help consider educational outcomes in terms of the required knowledge, skills and attitudes needed to promote these values-based approaches in practice.

RESULTS

A number of themes have been identified that lend themselves to educational application. International frameworks exist that provide some basis for the developments of recovery and social inclusion approaches in mental health practice, however the review identifies specific areas for future development.

CONCLUSIONS

This is the first article that attempts to scope the knowledge, attitudes and skills required to deliver education for Master's level mental health nurses based upon the principles of recovery and social inclusion. Emotional intelligence theory may help to identify desired outcomes especially in terms of attitudinal development to promote the philosophy of recovery and social inclusive approaches in advanced practice. Whilst recovery is becoming enshrined in policy, there is a need in higher education to ensure that mental health nurse leaders are able to discern the difference between the rhetoric and the reality.

A review of social inclusion measures

BACKGROUND

Social inclusion is crucial to mental health and well-being and is emphasised in Australia's Fourth National Mental Health Plan. There is a recognition that a measure of social inclusion would complement the suite of outcome measures that is currently used in public sector mental health services. This paper is an initial scope of candidate measures of social inclusion and considers their suitability for this purpose.

METHODS

We identified potential measures through searches of PsycINFO and Medline and a more general Internet search. We extracted descriptive and evaluative information on each measure identified and compared this information with a set of eight criteria. The criteria related to the measure's inclusion of four domains of social inclusion outlined in Australia's Fourth National Mental Health Plan, its usability within the public mental health sector and its psychometric properties.

RESULTS

We identified 10 candidate measures of social inclusion: the Activity and Participation Questionnaire (APQ-6); the Australian Community Participation Questionnaire (ACPQ); the Composite Measure of Social Inclusion (CMSI); the EMILIA Project Questionnaire (EPQ); the Evaluating Social Inclusion Questionnaire (ESIQ); the Inclusion Web (IW); the Social and Community Opportunities Profile (SCOPE); the Social Inclusion Measure (SIM); the Social Inclusion Questionnaire (SIQ); and the Staff Survey of Social Inclusion (SSSI). After comparison with the eight review criteria, we determined that the APQ-6 and the SCOPE-short form show the most potential for further testing.

CONCLUSIONS

Social inclusion is too important not to measure. This discussion of individual-level measures of social inclusion provides a springboard for selecting an appropriate measure for use in public sector mental health services. It suggests that there are two primary candidates, but neither of these is quite fit-for-purpose in their current form. Further exploration will reveal whether one of these is suitable, whether another measure might be adapted for the current purpose or whether a new, specifically designed measure needs to be developed.

Concepts of social inclusion, exclusion and mental health: a review of the international literature

Social inclusion and exclusion are concepts which have been widely associated with politics and policy in the first decade of the 2000s. People with mental health problems have become the focus of a range of social inclusion initiatives. A literature review was conducted to explore the peer-reviewed evidence relating social inclusion/exclusion and mental health. In total 36 papers were included in the review from the UK, Canada, Australia and Scandinavia. The papers had used a range of different approaches to research and evaluation. The included papers associated being socially included to: social roles and responsibilities such as employment, participation in social activities, environmental work and voting. Although some papers engaged in a critical discussion of the concept, many offered only simplistic accounts or definitions. Social inclusion is such a widely used term within political and policy discourses that it is surprising so little research is available within the mental health realm. There was a lack of clarity related to the concept of social exclusion and the qualitative studies focused entirely on the experiences of being excluded within an institutional or semi-institutional setting. The relationship between exclusion, inequality and injustice is identified and the relevance of the concept to current and future mental health policy is questioned.

Exploring Mental Health Service Users' Experiences of Social Inclusion in their Community Occupations

Introduction:

Social inclusion is a recent policy driver, which aims to develop fair access to opportunity for marginalised groups: a major goal in keeping with the values of occupational therapists. Evaluation of progress towards social inclusion includes listening to individuals' experiences of inclusion or exclusion in their local communities. This research aimed to explore the experiences of social inclusion for mental health service users when engaged in everyday community occupations and to identify possible factors that influenced the service user experience.

Method:

Eight in-depth interviews with mental health service users were carried out, using interpretative phenomenological analysis to recount participants' life world perspectives.

Findings:

The findings revealed three themes: the outside experience, which described features of the social, physical and economic environment that influenced inclusion; the internal disability, which described features within participants themselves that influenced inclusion; and an active lifestyle, which described how features of occupation influenced inclusion. Feelings of inclusion or exclusion were predominantly linked to the response received from others, which was at times stigmatising and hostile.

Conclusion:

Given the negative impact of the reactions of society, occupational therapists need to prioritise working with local communities to facilitate their capacity to support social inclusion, as well as focusing on individual skill acquisition.