Stephen Clift

Gay men and tourism: destinations and holiday motivations.

Abstract Little research attention has been given to the gay tourist market, the destinations most commonly visited by gay men, or their holiday motivations and experiences. This paper presents findings on the tourist destinations and holiday motivations of 562 gay men resident in southern England, who took part in a self-completion questionnaire survey to assess sexual activity and sexual risk behaviours in holiday settings. The study was aimed at informing HIV prevention intiatives for gay men with a tourism focus. Samples of men were recruited through contact in bars/clubs in Brighton and via a postal survey conducted in association with a local lesbian/gay magazine. The bar sample was younger than the postal sample but similar in terms of partnership status, income, holiday motivations and travel patterns. The two samples were thus combined for the purpose of analysis. The sample cannot be regarded as representative of gay men in general but does constitute a broad cross-section of gay men, mainly below the age of 40 on the commercial gay scene, supplemented by consumers of a local gay magazine. Gay men in the sample had travelled very widely in the previous five years, with southern European destinations and the United States, in particular, attracting substantial proportions of men. Three dimensions of gay tourist motivation were identified: ‘gay social life and sex’, ‘culture and sights’ and ‘comfort and relaxation’. Men who had visited southern European gay resorts (Gran Canaria, Ibiza and Mykonos) had significantly higher scores on the first dimension; whereas men who had visited European cities (Amsterdam, Paris and Prague) and had travelled further afield (sub-Saharan Africa and Australia) had higher scores on the second dimension. The implications of the findings for the development of tourism services for gay men, further research on gay tourism, and sexual health promotion aimed at gay men on holiday are discussed.

Mental health promotion through supported further education: The value of Antonovsky's salutogenic model of health

Purpose – The purpose of this research is to report on an evaluation of a programme of supported education in a Further Education context for students with long‐term mental health problems, based on Antonovskys Salutogenic model of health. The students are referred by the Community Mental Health Team.Design/methodology/approach – Three consecutive cohorts of students (n=148, 93 male, 55 female; average age 39.5 years) undertaking the programme, completed Antonovskys Short‐form Sense of Coherence scale (the SOC13) on entry to the programme, and when exiting from it. Qualitative feedback from the second cohort of students was examined to establish the processes at work in the programme. This identified a number of themes relating to the processes at work in the programme and its outcomes (Peer Support, Learning Support, Learning Effects, Symptom Reduction and Positive Affect) and provided a basis for designing short questionnaires, which were completed by the second cohort. Data from these questionnaires ...

“Singing for Breathing”: Participants' perceptions of a group singing programme for people with COPD

Background: Chronic obstructive airways disease (COPD) is a long term respiratory condition with a high prevalence rate and associated with considerable physical and psychological morbidity. This research aims to examine the perceptions of people with COPD taking part in regular group singing, in terms of feasibility, acceptability and effectiveness. Methods: The overall approach was a pre-test, post-test feasibility element and a nested qualitative component. Measures of respiratory function and self-reported quality of life were collected from participants engaged in a 36 week singing programme. Written comments from 97 individuals, reported here, were collected at baseline, mid-point and end-point. Data were analysed using content and thematic analysis. Results: Participants noted limitations due to their respiratory condition but a large number expressed beliefs that singing had led to improvement and this appeared to be incremental over the time of the project. Other comments related to positive effects on physical health more broadly, on psychological wellbeing and on the social support gained through meeting others with COPD. Comments relating to the overall programme and the research itself were overwhelmingly positive. Conclusions: Findings suggest that singing is perceived as both acceptable and beneficial to people with COPD. Evidence from participants served as a useful supplement to the quantitative findings.

Arts, health & wellbeing: reflections on a national seminar series and building a UK research network

Abstract An account is provided of a UK national seminar series on Arts, Health and Wellbeing funded by the Economic and Social Research Council during 2012–13. Four seminars were organised addressing current issues and challenges facing the field. Details of the programme and its outputs are available online. A central concern of the seminar programme was to provide a foundation for creating a UK national network for researchers in the field to help promote evidence-based policy and practice. With funding from Lankelly Chase Foundation, and the support of the Royal Society for Public Health, a Special interest Group for Arts, Health and Wellbeing was launched in 2015.

Supported further education provision for people with long-term mental health needs. Findings from a survey of further education colleges and primary care trusts across the south east of England

Aim: Government policy has highlighted the need for inclusive education for people with long-term mental health needs. As a starting point, the aim of this study was to assess the extent to which further education (FE) colleges in the south east of England provide supported education for people with mental health needs, and the extent to which these organizations collaborate with local NHS primary care trusts (PCTs). Also, to assess the potential numbers of people who might benefit from fully inclusive educational provision needs assessment, together with the potential healthcare cost savings. Method: A survey was conducted of 33 multi-faculty FE colleges and 49 PCTs via structured telephone interviews with nominated representatives, in order to collect quantitative and qualitative data of the provision of supported education provision for people with mental health needs. The FE survey enquired whether they had provision for people with mental health needs, and if so, the details. The PCT survey gathered data on their caseload of standard and enhanced clients for the population covered, and the extent to which they were aware of the benefits of learning on mental health. Results: Only 15 FE colleges (45%) had some form of provision for students with long-term mental health needs, and only six PCTs (12%) provided an educational link co-ordinator. FE colleges with existing provision averaged 70 students per college, against an attainable potential target of 130 students per college. Encouragingly, cohorts of students with mental health needs were reported to have levels of ‘retention’, ‘achievement’ and ‘success’ rates that were comparable with students from the general population on mainstream courses — e.g. expected rates of around 85% retention, 75% achievement (of those retained), 65% success (overall from enrolled to achieving), with some 5% progressing to university and 12% into employment. On present levels of FE recruitment, there is a potential net saving to the taxpayer of £13 million in mental healthcare costs (around 50%) and if recruitment increased to projected levels, then the potential net saving to the taxpayer would be £26 million. The substantial estimated savings to the health budget not only shows that supported education provision in FE is effective in promoting mental health, it also indicates the high level of its cost-effectiveness. Conclusion: This research has implications for budget holders, health promotion staff and mental health teams working within a social model of health, and the collaborative use of resources to assist people recovering from or managing mental health difficulties in moving forward in their lives.

An evidence base for mental health promotion through supported education: a practical application of Antonovsky's salutogenic model of health

Abstract 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 Antonovskys 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.

Antonovsky Revisited – Implications for Mental Health Promotion Practice

The paper assesses the validity of Antonovskys (1996) assertion that health promotion should use the salutogenic model of health to guide practice, by drawing on the results of an evaluation of a supported further education programme for people with long-term mental health needs. Three consecutive cohorts of further education (FE) students with a long-term mental health diagnosis were assessed before and after participation, using Antonovskys (1987) short form Sense of Coherence questionnaire (SOC-13). Students with SOC13 scores 52 and above at entry showed no significant change. However, students with entry SOC13 scores below 52 made statistically significant positive gains in their exit scores. A causation model was developed from qualitative evidence from students’ accounts of participation in the programme. The results of short questionnaires provided numerical data for building a model of the relationships between the themes and SOC13 scores. The model suggests that peer support is an important factor in the success of the programme and that the activity of learning reduced symptoms and raised positive affect. The results of this study support the value of Antonovskys salutogenic health perspective for mental health promotion staff and allied professionals, and highlight the need for mental health professionals to pay attention to the pathogenic and salutogenic paradigms for understanding the health needs of people with long-term mental health needs.

The Open Door programme: student journeys to employment and university

Changes in government policies threaten to remove an important source of funding that enables people with mental health problems to be supported to enter and progress from further education to employment and university. Ian Morrison and Stephen Clift describe one such scheme whose future is in doubt, and the journeys undertaken by some of the people it has supported.

Creative Arts and Public Health

During 2013, I have had the privilege and pleasure of presenting at two international conferences on recent research undertaken by the Sidney De Haan Research Centre for Arts and Health on the value of singing for people affected by chronic obstructive pulmonary disease (COPD). The first in the company of researchers and practitioners from around the world closely involved in the developing field of arts and health, and the second with researchers and practitioners in the wider field of public health. The contrasts between the two conferences were instructive, and point to both the opportunities and the challenges of mainstreaming an understanding of the relevance and power of creative arts in the wider public health field. The first was the Culture, Health and Wellbeing International Conference, which took place in Bristol, UK, in June, organised by the South West Arts and Health Partnership and sponsored by the UK Royal Society for Public Health. Alan Haworth, a member of the UK House of Lords and former Minister for the Arts, gave an inspiring and wide-ranging keynote address which set the tone for the entire conference. A full transcript of the speech is available and I recommend that everyone in the arts and health field read it. Just a short extract gives an indication of the tenor of his advocacy for the arts. He sets this in the context of what he referred to as the ‘pathology of the west’ driven by forces such as a classical economics view of human nature, an increasingly ascendant bio-medical view of health and the rising dominance of digital technologies:

Arts on prescription for community-dwelling older people with a range of health and wellness needs

Abstract Published evidence for the role of participatory art in supporting health and well‐being is growing. The Arts on Prescription model is one vehicle by which participatory art can be delivered. Much of the focus of Arts on Prescription has been on the provision of creative activities for people with mental health needs. This Arts on Prescription program, however, targeted community‐dwelling older people with a wide range of health and wellness needs. Older people were referred to the program by their healthcare practitioner. Professional artists led courses in visual arts, photography, dance and movement, drama, singing, or music. Classes were held weekly for 8–10 weeks, with six to eight participants per class, and culminated with a showing of work or a performance. Program evaluation involved pre‐ and postcourse questionnaires, and focus groups and individual interviews. Evaluation data on 127 participants aged 65 years and older were available for analysis. We found that Arts on Prescription had a positive impact on participants. Quantitative findings revealed a statistically significant improvement in the Warwick–Edinburgh Mental Well‐being Scale (WEMWBS) as well as a statistically significant increase in the level of self‐reported creativity and frequency of creative activities. Qualitative findings indicated that the program provided challenging artistic activities which created a sense of purpose and direction, enabled personal growth and achievement, and empowered participants, in a setting which fostered the development of meaningful relationships with others. This evaluation adds to the evidence base in support of Arts on Prescription by expanding the application of the model to older people with a diverse range of health and wellness needs.