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      Social enterprises’ impact on older people’s health and wellbeing: exploring Scottish experiences

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          Abstract

          The global aging demographic is putting pressure on state-delivered health and social care services. As the austerity agenda in the UK cuts state-funded service provision for older people despite increasing demand, social enterprise has become a politically and economically attractive model for the sustainable delivery of some public services. Yet little is known about the impact of social enterprise on the health and wellbeing of older people. In this paper we address this gap in understanding and consider social enterprise activities as complex public health-promoting interventions. Our study aimed to understand what impact social enterprise activities had on the health and wellbeing of participants aged over 50, and also how that impact was created. To achieve this, we conducted qualitative semi-structured interviews with a sample ( n = 43) of staff, volunteers, clients and carers aged over 50 who were involved in activities delivered by three social enterprises. Using a thematic analysis to explore manifest and latent themes, two antecedents of subjective younger age emerged explaining how benefit was created, namely downward social comparison and identity. The social enterprise activities we studied benefited participants' health and wellbeing, impacting positively on participants' sense of purpose, social support, connectedness and inclusion. These health and wellbeing benefits can be considered as outcomes of complex public health interventions for older people, and we relate these outcomes to beneficial conditions within the intermediary social determinants of health. We conclude by discussing the future impact of social enterprise activities and current UK policy on the structural determinants of health.

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          Developing and evaluating complex interventions: the new Medical Research Council guidance

          Evaluating complex interventions is complicated. The Medical Research Council's evaluation framework (2000) brought welcome clarity to the task. Now the council has updated its guidance
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            Stigma as a fundamental cause of population health inequalities.

            Bodies of research pertaining to specific stigmatized statuses have typically developed in separate domains and have focused on single outcomes at 1 level of analysis, thereby obscuring the full significance of stigma as a fundamental driver of population health. Here we provide illustrative evidence on the health consequences of stigma and present a conceptual framework describing the psychological and structural pathways through which stigma influences health. Because of its pervasiveness, its disruption of multiple life domains (e.g., resources, social relationships, and coping behaviors), and its corrosive impact on the health of populations, stigma should be considered alongside the other major organizing concepts for research on social determinants of population health.
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              A meta-analysis of interventions to reduce loneliness.

              Social and demographic trends are placing an increasing number of adults at risk for loneliness, an established risk factor for physical and mental illness. The growing costs of loneliness have led to a number of loneliness reduction interventions. Qualitative reviews have identified four primary intervention strategies: (a) improving social skills, (b) enhancing social support, (c) increasing opportunities for social contact, and (d) addressing maladaptive social cognition. An integrative meta-analysis of loneliness reduction interventions was conducted to quantify the effects of each strategy and to examine the potential role of moderator variables. Results revealed that single-group pre-post and nonrandomized comparison studies yielded larger mean effect sizes relative to randomized comparison studies. Among studies that used the latter design, the most successful interventions addressed maladaptive social cognition. This is consistent with current theories regarding loneliness and its etiology. Theoretical and methodological issues associated with designing new loneliness reduction interventions are discussed.
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                Author and article information

                Journal
                Health Promot Int
                Health Promot Int
                heapro
                Health Promotion International
                Oxford University Press
                0957-4824
                1460-2245
                October 2020
                09 October 2019
                09 October 2019
                : 35
                : 5
                : 1074-1084
                Affiliations
                [1 ] Research and Innovation Office
                [2 ] Yunus Centre for Social Business and Health, Glasgow Caledonian University , Cowcaddens Road, Glasgow G4 0BA, UK
                Author notes
                Corresponding author. E-mail: fiona.henderson@ 123456gcu.ac.uk
                Author information
                http://orcid.org/0000-0002-1175-2940
                Article
                daz102
                10.1093/heapro/daz102
                7585484
                31598672
                7ce0f09b-7f8e-4e94-b0a0-ce70ff3d95d5
                © The Author(s) 2019. Published by Oxford University Press.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Pages: 11
                Funding
                Funded by: Medical Research Council and the Economic and Social Research Council;
                Award ID: MR/L003287/1
                Categories
                Original Articles
                AcademicSubjects/MED00860

                Public health
                social enterprise,older people,health
                Public health
                social enterprise, older people, health

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