Community participation

1
Community participation psychological distress

• Helen L Berry
• National Centre for Epidemiology Population
  Health
• ANU College of Medicine Health Sciences

2
Acknowledgements

• Eurobodalla Shire Council, Eurobodalla Shire, New
  South Wales, Australia
• Sponsored Eurobodalla Study (data collection)
• Australian Government Department of Families,
  Communities and Indigenous Affairs
• Social Policy Research Grant FCH 2006/02 (for
  this study)
• Megan Shipley, NCEPH, ANU CMHS
• Research assistance

3
Background Community participationReferences
Berry et al. 2007 last slide

• Community participation important for health
• including mental health (X-sectional,
  prospective, onset, course, recovery)
• depression, anxiety, psychosis, schizophrenia,
  distress, cognitive decline
• thru life, sex, ethnicity, worldwide, rich
  poor nations, rural urban
• But no theory of participation, no systematic
  investigation
• Dont know
• what participation is
• which kinds matter for MH
• why related to MH some studies find it is not,
  or very weak
• if appropriate health promotion strategy

4
Background (ii)Perceptions about community
participation

• Media talk of longing for community, of not
  connecting enough emotional topic
• No systematic investigation of thoughts
  feelings
• Perceptions highly predictive of MH
• eg., close concept social support
• How perceptions about participation are related
  to MH
  

5
Aims

• Report on relationship between
• Frequency of participation
• Perceptions about participation
• Investigate relationship between frequency of and
  perceptions about participation, and distress
• Type or breadth?
• Investigate an explanatory hypothesis about why
  participation may be related to distress

6
The Eurobodalla Study

• Self-report mail survey 2001-02
• Funded by Eurobodalla Shire Council
• N 963 adults 18-97
• Random sample from electoral rolls Eden-Monaro
• Stratified by sex and age
• Eurobodalla Shire, southern NSW
• Coastal region, 40,000, 80 in three towns,
  tourism
• Low employment, low income, low education,
  retirement destination, so ageing (among oldest)

7
Are mental health and participationreally linked?

• No background factors cause both
• intrinsic (eg, personality, disability)
• extrinsic (eg, poverty, rural remote vs
  metropolitan)
• Yes mental health problems are a barrier to
  participation
• social drift
• stigma
• Yes community causation
• social capital theory
• Evidence for all reciprocal causation,
  mediation moderation

8
What sorts of activities make up volitional
community participation?

• Being on a school board
• Being in a choir
• Visiting extended family
• Signing petitions
• Emailing friends
• Writing to a newspaper editor
• Living with others
• Volunteering
• Going on talk-back radio
• Standing for election

• Babysitting clubs
• Voting (formally)
• Eating together
• Chatting with neighbours
• Reading newspapers
• Tea breaks with colleagues
• Collecting for charity
• Organising an activist group
• Playing sport
• Discussing current affairs

9
Hypothetical structureof volitional community
participation
10
Measuring frequency of participation

• Australian Community Participation Questionnaire1
• Theory-based self-report instrument
• 67 items
• 14 different types of participation (EFA OFCM)
• response format 1 (never) 7 (very often)
• multi-item weighted sub-scales means, Sx

1. Berry, H.L., Rodgers, B. Dear, K.B.G.
(2007). Preliminary development and validation of
the Australian Community Participation
Questionnaire Types of participation and
associations with distress in a coastal region.
Social Science Medicine, 64(8), 1719-1737.
11
Unfitted fitted one factor congeneric modelsof
Community Activism
Unfitted model
Fitted model
12
Frequency of community participationordered most
to least common
13
Frequency of participation and MH

• Relationship between each type of participation
  and MH
• K10 general psychological distress general
  indicator of mental health
• Multiple regression analysis
• controlling for wide array of socio-demographic
  factors
• Not in paid work, financial disadvantage (health
  care card), live alone, Indigenous Australian,
  high school or less
• 9 (of 14) types of participation independently
  related to distress
• All small relationships (r .11 to -.20)
• 5 n.s. at plt.05
• 2 worse distress (political)
• 7 less distress Big 7

14
Big 7 types of community participation
15
Breadth of participation

• Breadth of community participation
• more important than any one type?
• small correlations
• Big 7 or all 14?
• all 14 types of participation dichotomised by
  mean split
• score of 1 (at or above M) or 0 (below)
• count how many above mean ANOVA, index grouping
  variable
• Index 1
• based on Big 7
• 8-pt index, range 0-7
• Index M3.60, Sx1.61

• Index 2
• based on all 14
• 15-pt index, range 0-14
• Index M6.14, Sx2.89

16
Breadth of community participation general
psychological distress
Big 7 Index

• Breadth strongly linearly related to distress
• But only Big 7
• Use Big 7 index of breadth of participation

Estimated marginal means controlling for
socio-demographic factors
17
Perceptions about participation

• Perceptions about participation2
• Too much or too little
• for each type of participation
• 5-point response format, 1 (much too much) 5
  (much too little)
• irrespective of frequency
• Enjoyable or not enjoyable
• for each type of participation
• 5-point response format, 1 (very enjoyable) 5
  (very unenjoyable)
• N/a category allowed

2. Berry, H.L. Shipley, M. (forthcoming).
Longing to belong Social capital and mental
health in a coastal Australian region.
18
Indices of perceptions about participation

• Four more indices for perceptions about
  participation
• also based on Big 7
• same relationship to distress as breadth
• procedure as for breadth index
• range 0-7
• Too much or too little?
• too much M.24, Sx.54
• too little M2.31, Sx1.50
• Enjoyable or not enjoyable?
• not enjoyable M.15, Sx.48
• enjoyable M2.41, Sx1.80

19
Breadth, perceptions distress
Note Pearson Product Moment correlations,
significant at plt.05, plt.01, plt.001.
20
Explanatory hypothesisPersonal social capital

• Personal social capital3
• Community participation (breadth, perceptions)
• Personal social cohesion
• Universalism (Schwarz, 1992)
• Sense of belonging (Cohen et al. 1985)
• Generalised reciprocity (Inglehart et al. 1997)
• Social trust (Cummins Bromiley 1996 Berry et
  al. 2000 2003 2005 Inglehart et al. 1997)
• Optimism (Scheier 1994)
• Implied causality structural equations modelling

3. Berry, H.L., Rickwood, D.J. (2000).
Measuring social capital at the individual level
Personal Social Capital, values and
psychological distress. International Journal of
Mental Health Promotion, 2(3), 35-44.
21
Hypothetical modelPersonal social capital and
distress
22
Structural equations modelling

• Confirmatory, hypothesis-driven technique
• Combines factor analysis, MH regression, ANOVA
  path
• Basic units are measurement models
• One-factor congeneric models (OFCMs) concept
  factor models
• Build them first
• SEM may include observed variables, OFCMs and
  CFMs
• Modify models
• Delete n.s. paths or items
• Modification indices
• Fit indices (absolute relative fit, overfit)
• All concepts in model must be significantly
  associated according to hypothetical model

23
Participation, cohesion distress
Note Pearson Product Moment correlations,
significant at plt.01, plt.001.
24
Building the structural model Procedure

• Complete all OFCMs, then assemble theory,
  confirmatory
• Socio-demographic disadvantage controls (as OFCM)
• Community participation (as OFCM)
• breadth (one index)
• perceptions (four indices)
• Personal social cohesion (OFCM)
• universalism
• sense of belonging
• reciprocity
• social trust (weighted composite from OFCM)
• optimism
• Psychological distress (observed variable)

25
Building the one-factor congeneric
modelsSocio-demographic disadvantage
26
Building one-factor congeneric modelsCommunity
participation
27
Building one-factor congeneric modelsPersonal
social cohesion
28
Building the structural model with
distressAssemble OFCMs into hypothesised model
29
Until eventually ..Full structural model of
personal social capital distress
30
Stripped structural model ofpersonal social
capital distress
31
Study limitations Untangling required

• Need to address causality pathways
• X-sectional cant do this, but can
• Summarise factors how related, especially SEM
• Confirm/ disconfirm plausibility of hypotheses
• Possible explanations other than social capital
• Community level selection (untested)
• social types move to high participation
  neighbourhoods
• People with MH problems less responsive to
  stress-buffering effects of participation (some
  evidence)
• Relationship community and individual level
  factors
• Measure individual participation MH (good)
• Need to measure ecological level participation
  MH (not aggregate)
• Relationship between community individual (ML
  models)

32
Conclusions implications

• Participation strongly related to distress
• breadth perceptions (enjoyment, too little)
• Community causation (personal social capital)
  plausible
• media sense about longing for connectedness
• Conceptualisation measurement vital
• no relationship between participation MH?
• yes? no? confounded? Direction of association?
• never properly measured perceptions never
  studied
• Some types matter, some dont, some dangerous
• Participation as a MH promotion strategy?
• specificity Big 7, not just any type
• breadth across specific types

33
References

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  National Health Promotion Conference. Perth,
  Western Australia.
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  C.J., Cox, E.M., Alexander, K.M., Potter, R.C.
  (2000). Epidemiology of participation an
  Australian community study. Journal of
  Epidemiology Community Health, 54(6), 414-423.
• Berry, H.L., Rickwood, D.J. (2000). Measuring
  social capital at the individual level Personal
  Social Capital, values and psychological
  distress. International Journal of Mental Health
  Promotion, 2(3), 35-44.
• Berry, H.L., Rodgers, B. (2003). Trust and
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• Berry, H.L., Rodgers, B., Dear, K.B.G. (2007).
  Preliminary development and validation of the
  Australian Community Participation Questionnaire
  Types of participation and associations with
  distress in a coastal region. Social Science
  Medicine.
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