An Evidence Base for Mental Health Promotion through Supported Education: A Practical Application of Antonovsky's Salutogenic Model of Health
Morrison, Ian, Stosz, Laura M., Clift, Stephen M., International Journal of Health Promotion and Education
Purpose This paper reviews the literature for evaluation studies that might fulfil the criteria of evidence-based medicine (EBM) in the specialism of 'supported education for people with long-term mental health needs', with a view to justifying the efficacy of these initiatives and attracting the associated funding.
Design and methods A review of the literature was conducted for supported education evaluation studies that might fulfil the criteria of EBM. The methodologies of the studies found were examined both for appropriateness to the initiative being undertaken, and to what extent it complied with EBM. A recently developed and implemented evaluation methodology of supported education conducted over three years in a further education (FE) college (Morrison & Clift 2006) was then examined in the light of the above findings, with a view to attempting to overcome major difficulties and confirm outcomes.
Results Currently, the literature has few examples of programme evaluations that meet EBM criteria, which might convince budget holders of the efficacy of supported education. However, those that are available have consensus in their findings of the positive outcomes and the associated causative reasons. For the future, a recently developed and implemented triangulated evaluation methodology, and using Antonovsky's short-form Sense of Coherence questionnaire (SOC-13) as a test, retest instrument, has been successful in answering the dichotomy of rigour with appropriateness, and issues of consistency of evaluation methods and reducing the multitude of measuring instruments found in present studies. Implications This research has government target implications for budget holders, health promotion staff and mental health teams working within the recovery model of health, in the collaborative use of resources to assist people recovering from or managing mental health difficulties to move forward in their lives.
Conclusion This study offers an appropriate and rigorous methodology and test, retest instrument for a non-randomised control trial suitable for the social sciences, and especially for evaluating supported education initiatives, so that they can be properly validated and attract funding. It also supports the cost benefits of mental health promotion for those recovering from or managing their mental health needs.
Key words: evidence-based medicine, Antonovsky, supported education, mental health promotion.
The main criterion for any health promotion practice is effectiveness, which is demonstrated by an evidence base (Goldenberg 2006, Harrison 1998). The system of evaluating research using a hierarchy and basing practice on that system is known as evidence-based medicine (EBM) (Harrison 1998). While EBM is the generally accepted norm for biomedical illnesses, questions of efficacy arise when the targeted problem and potential cure may be of a psychosocial nature. Herein lies the practice of supported education as rehabilitation for people with mental health illnesses. Supported education refers to a programme in which adults with mental health needs receive formal support to undertake a post-secondary course. Education is a form of social rehabilitation and provides a normalising experience in which the participant can assume a separate identity from 'psychiatric patient' (Collins et al 1998). However, while there is agreement in the research on the effectiveness of supported education, application of a biomedical-biased hierarchical evidence framework unduly suggests weakness as an evidence base for practice.
There are a number of problems within the theory of EBM (Cohen et al 2004, Evans 2003). While the idea driving EBM is not to subject people to ineffective interventions (Harrison 1998), Cohen et al (2004) argue that it is an unproven theory in medicine, as it has not been shown to provide better results than traditional forms of healthcare decision-making. …