ANSWER
The recovery-oriented approach, which is based on the underlying principles of hope, empowerment, choice, and self-determination, has grown in popularity for use in the development, provision, and evaluation of services and resources for people with mental health problems (Tondora, Miller, Slade, & Davidson, 2014). The recovery-oriented approach is gaining popularity.
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The positive psychology movement has been paralleled, and both approaches emphasize personal fulfillment, meaningful engagement, and overall well-being rather than symptom remission (Resnick & Rosenheck, 2006). Moran and Nemec (2013), in particular, outline hedonic (i.e., understanding of happiness and pleasure attainment) and eudaimonic (i.e., meaning discovery and self-realization) approaches as contributing to a meaningful and fulfilling life. As the leisure literature supports a wide range of recovery-oriented benefits to meaningful engagement, including improved overall health, physical functioning, and quality of life (Iwasaki, Coyle, & Shank, 2010), these theoretical frameworks can provide a lens for understanding how recreation activities can contribute to recovery for individuals with mental illness.
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Lara Fenton is now an Assistant Professor in the Faculty of Kinesiology and Recreation Management at the University of Manitoba.
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L. FENTON & CO., 2010). Recovery frameworks guide mental health services, and it is becoming increasingly clear that, in addition to focusing on individuals, these services must also address social justice and inclusion issues (Davidson, Tondora, Lawless, O’Connell, & Rowe, 2009).
This includes creating opportunities for recovery in communities and with others.
Spending time in community recreation programs and spaces promotes recovery (i.e., a nonlinear journey to well-being) and social inclusion (i.e., community integration) in people with mental illnesses. Much of this evidence has accumulated in the last decade and, while largely unanalyzed, suggests that a variety of community recreation types (e.g., physical recreation and activity/exercise, social recreation, and creative pursuits) may improve physical health and reduce symptoms associated with mental illness (Conn, 2010a, 2010b; Iwasaki, Coyle, & Shank, 2010).
To date, scientific research has primarily focused on defining the physical and psychological benefits of participation in organized physical recreation, with components of this evidence synthesized (e.g., McDevitt et al., 2006; Penedo & Dahn, 2005; Street et al., 2007; Sylvia et al., 2013). Physical recreation has been shown to have a variety of benefits, including weight loss (Bartels et al., 2013), improved cardiovascular health (McDevitt et al., 2006), increased energy (Street et al., 2007), a better sense of belonging and community (Eime, Young, Harvey, Charity, & Payne, 2013), and a reduction in symptoms associated with mental illness (Conn, 2010a, 2010b). Programs that have been shown to improve the physical health of people suffering from mental illnesses are critical, given that these people often lead inactive lifestyles, are more likely to be overweight and are at a higher risk than the general population of developing chronic conditions such as hypertension, diabetes, and cardiovascular disease (Bonsaksen & Lerdal, 2012).
In addition to research into the physical and psychological benefits of physical activity, There is a great deal of interest in understanding the barriers and facilitators to physical recreation participation among people with mental illnesses (e.g., Carless and Douglas, 2012; Happell, Platania-Phung, and Scott, 2011; McNeill, Kreuter, and Subramanian, 2006). Internal barriers (those that arise within a person) include symptoms, thoughts, feelings, and perceptions that may impede participation (Carter-Morris & Faulkner, 2003). People with mental illnesses, for example, frequently experience depression, fatigue, or crowd-induced anxiety, making participation in community-based activities challenging (Craik & Pieris, 2006; Roberts & Bailey, 2011). Internal barriers are mitigated by healthcare professionals with specialized training in this domain; however, external barriers are perceived within the environment and are thus of particular importance to leisure scholars and recreation practitioners who are charged with the responsibility of creating accessible and inclusive community spaces (McNeill et al., 2006). Environmental barriers may include a lack of flexible alternatives (e.g., activities at convenient times, appropriate levels, and convenient locations), limited social supports/companionship, a lack of finances (Smyth, Harries, & Dorer, 2011), and perceived stigma and discrimination in recreation spaces (De Herdt et al., 2013; Iwasaki, Coyle, Shank, Messina, & Porter, 2013).
Aside from physical recreation, there is a substantial body of scientific literature describing the ability of other types of community recreation (e.g., social and creative-based initiatives) to similarly affect psychological recovery and social inclusion in people with mental illnesses. Iwasaki and colleagues propose that “efforts to promote active living include enjoyable, expressive, and meaningful leisure experiences[Italics added]” (Iwasaki et al., 2014, p. 149), providing LEISURE SCIENCES 3 support for further research into hedonic and eudaimonic approaches. Beneficial community recreation programs are defined as places where a person is not identified as a patient, where they can interact with supportive others, and where they can participate in personally meaningful activities (Sells et al., 2006); some research suggests that these welcoming and inclusive environments are the first step toward developing personally meaningful relationships that influence social inclusion (Schleien, Green, & Stone, 2003).
Reduced symptoms of mental illness (Dingle, Brander, Ballantyne, & Baker, 2013; Iwasaki et al., 2014; Iwasaki et al., 2010), social connections and support (Hebblethwaite & Pedlar, 2005), increased sense of belonging (Iwasaki et al., 2014). Social inclusion is a benefit of these recreational activities (Donnelly & Coakley, 2002). Unlike the literature on physical recreation, however, this literature, as well as perceived barriers and facilitators, has not been formally synthesized. Furthermore, the characteristics of community recreation programs that promote recovery still need to be discovered.
In conclusion, there is emerging evidence that community-based creative and social recreation may promote recovery and social inclusion among people with mental illnesses (Iwasaki et al., 2014; Iwasaki et al., 2010). Unlike the literature on physical recreation, this literature has yet to be synthesized, making it challenging to conclude practical approaches and research gaps (Levac, Colquhoun, & O’Brien, 2010). As a result, an investigation into the benefits of participation and the characteristics of community-based recreation initiatives that are pleasurable and meaningful, as well as those that facilitate recovery and social inclusion, is required.
An integrative review helps assess and integrate existing empirical research. The method differs from systematic reviews in that it allows for the integration of knowledge derived using various methodologies, clarifies concepts, and provides direction for future research within a given area (Whittemore & Knafl, 2005). This article seeks to synthesize current empirical literature and present and describe the benefits, barriers, and facilitators to participation in community-based recreation thought to promote recovery and social inclusion among people with mental illnesses through an integrative review.
Methods
This article synthesizes current research and presents the benefits, barriers, and facilitators of participation in community-based recreation to promote recovery and social inclusion among people with mental illnesses using an integrative review. It also delves into the characteristics of successful programs. The integrative review process is described by Whitemore and Knafl (2005) in five steps: 1) clear identification of the problem that the review is addressing; 2) articulating well-defined parameters for the literature search; 3) critical appraisal of the methodological quality of the literature; 4) data analysis of the primary studies, including coding and drawing a summative conclusion based on the analysis; and 5) data display, in which the results are presented. Each of these five steps is described in detail below.
Identifying the research problem
There needs to be a synthesis of research into the ability of community-based recreation to influence recovery and social inclusion for people with mental illnesses. A synthesis of the psychosocial benefits of community recreation, barriers to participation, and the four L. FENTON ET AL. program characteristics that participants believe are important in creating welcoming and inclusive community recreation environments needs to be improved.
Search the literature
A core group of research team members working in recreation and mental health developed the search terms to reflect our research questions best. The inclusion and exclusion criteria were created with community recreation providers in mind. We excluded, for example, interventions primarily based on therapy and required the provider to be certified to provide the program. This would exclude our target population as this would exclude many recreation workers. Furthermore, while comorbidities such as dementia or traumatic brain injury are frequently associated with mental illness, we needed to ensure a search criterion that focused more concisely on our target population of individuals with mental illness. The search terms were developed into a search protocol with the assistance of a reference librarian (see Appendix A). The authors have previously published randomized controlled trials and systematic reviews and have evaluated a wide range of qualitative and quantitative designs. The authors used the inclusion and exclusion criteria to review articles systematically found using the search protocol (See Appendix A) to guide the critical appraisal process (See Appendix B).
A critical evaluation
The 16-item QATSDD quality assessment tool was used by the researchers because it is the only tool specifically designed to evaluate diverse research approaches such as qualitative, quantitative, and mixed-method studies. The validity and reliability of the QATSDD have been assessed (Sirriyeh, Lawton, Gardner, & Armitage, 2012). The tool enables researchers to assess the quality and validity of the study’s methods and methodology rather than the results or how well the results address gaps in the literature. Each of the 16 items is scored from 0 (not at all) to 3, with two items dedicated solely to quantitative research and two to qualitative research (Sirriyeh et al., 2012). The critical appraisal was designed to provide an overall assessment of the quality of the literature that addressed our research question and to make recommendations for future research.
To achieve this goal, two researchers evaluated each included article (n = 35) for methodological consistency across the criteria. These criteria addressed several factors, such as the theoretical framework and the fit between the research question and the data collection method chosen (Sirriyeh et al., 2012). The two researchers then met to discuss the scores assigned to each item and reach an agreement. This iterative process resulted in a score for each article on 14 items, allowing the researchers to assess each article and the literature found in the integrative review.
Data examination
The lead author, who has experience with qualitative content analysis, coded each article after it was uploaded into Nvivo. The 35 included studies were analyzed by coding themes developed in each qualitative aspect of the studies and statistically significant results in the quantitative aspect. As with any results meta-analysis, many decisions were returned to the research team. In LEISURE SCIENCES 5, for example, there were some cases where quantitative and qualitative data contradicted each other. In these cases of contradictory results, we followed Cooper’s (1998) advice and compared the frequency of significant positive findings to the frequency of significant negative ones.
Furthermore, quantitative results that kept the participants as a whole group was preferred over quantitative results that focused on categorizing the participants, such as by age or living situation. Furthermore, some reported findings concentrated on the relationship between quantitative scales unrelated to time spent in a recreation program. These should be taken into account in our analyses. For studies involving qualitative data, we focused on the participant’s perspective rather than the programmer’s perspective, as Roberts and Bailey (2011) argue that focusing on service users’ perspectives is critical. Using the parameters listed above, the lead researcher created codes based on the research questions, employing a constant comparison method in which each new code was compared to previous codes for similarities (Patton, 2002). The codes that produced a similar pattern were then categorized into themes. A second researcher reviewed the codes and supporting evidence from each article to ensure the accuracy of the coding.
retrieved studies as a result
The systematic literature search is depicted in detail in Figure 1. The search yielded 12,429 hits from the nine databases examined. For an integrative review, this was a large number of articles. As a result, we double-checked the list’s necessity using the Medical Subject Headings (MeSH) terms “mental illness” and “mental health” in Pubmed.
This search yielded unique article lists relevant to the search, implying that the large number of articles included was required. To be clear, this is a relatively new area of study. As a result of the significant variability in the vocabulary used in a publication, the search terms are broad and make searching difficult. Others can now use search strategies like the one described in this study.
After removing duplicates, two researchers independently reviewed the titles and abstracts of 9,844 references using inclusion/exclusion criteria developed by the research team (see Appendix B). The two reviewers assigned “include,” “possibly include,” and “exclude” ratings to all articles. The two reviewers discussed the articles and the inclusion criteria to resolve disagreements, and the articles were ranked as possible inclusions.
Following this process, 45 articles were classified as “include” based on the inclusion and exclusion criteria (where we sought to include, for example, community-based initiatives that were not labeled as therapy). Because the assessment process had only used the title and abstract, there needed to be more information in some cases to exclude the article, such as whether the intervention occurred in a hospital or a community setting. At the time, the inclusion criteria were well established, and the first author reviewed the full text of these 45 articles. This re-evaluation determined that ten studies needed to meet the inclusion criteria. The total number of articles included was 35, and these reference lists were manually searched for articles (see Figure 1). The study excluded 10,009 articles because it only included institutions and institutionalized populations rather than community members and communities. A second primary reason was that the study reported physical activity and exercise but only included physiological measures and no social inclusion measures.
QUESTION
APA format
1) Minimum 12 pages (No word count per page)- Follow the 3 x 3 rule: minimum of three paragraphs per page
You must strictly comply with the number of paragraphs requested per page.
The number of words in each paragraph should be similar
Part 1: minimum 3 pages
Part 2: minimum 3 pages
Part 3: minimum 3 pages
Part 4: minimum 3 pages
Submit 1 document per part
2)¨******APA norms
The number of words in each paragraph should be similar
Must be written in the third person
All paragraphs must be narrative and cited in the text- each paragraph
The writing must be coherent, using connectors or conjunctive to extend, add information, or contrast information.
Bulleted responses are not accepted
Don’t write in the first person
Do not use subtitles or titles
Don’t copy and paste the questions.
Answer the question objectively, do not make introductions to your answers, answer it when you start the paragraph
Submit 1 document per part
3)****************************** It will be verified by Turnitin (Identify the percentage of exact match of writing with any other resource on the internet and academic sources, including universities and data banks)
********************************It will be verified by SafeAssign (Identify the percentage of similarity of writing with any other resource on the internet and academic sources, including universities and data banks)
4) Minimum 3 references (APA format) per part not older than 5 years (Journals, books) (No websites)
Parts 1 and 2: Minimum 6 references (APA format) per part not older than 5 years (Journals, books) (No websites)
All references must be consistent with the topic-purpose-focus of the parts. Different references are not allowed
5) Identify your answer with the numbers, according to the question. Start your answer on the same line, not the next
Example:
Q 1. Nursing is XXXXX
Q 2. Health is XXXX
Q3. Research is…………………………………………………. (a) The relationship between……… (b) EBI has to
6) You must name the files according to the part you are answering:
Example:
Part 1.doc
Part 2.doc
__________________________________________________________________________________
The number of words in each paragraph should be similar
Part 1: Psychopharmacology
Topic: Amitriptyline
1. Describe uses for treatment FDA approved (one paragraph)
2. Explain Off label uses (one paragraph)
3. Contraindications (one paragraph)
4. Mechanism of action (one paragraph)
5. Potential side effects(one paragraph)
6. Lab monitoring/ follow up (one paragraph)
7. Explain the role of the Psychiatric Mental Health Nurse Practitioner in the role of prescribing the medication (one paragraph)
8. Explain the role of the Psychiatric Mental Health Nurse Practitioner in the role of managing the medication (one paragraph)
9. Conclusion (one paragraph)
The number of words in each paragraph should be similar
Part 2: Psychopharmacology
Topic: Agomelatine
1. Describe uses for treatment FDA approved (one paragraph)
2. Explain Off label uses (one paragraph)
3. Contraindications (one paragraph)
4. Mechanism of action (one paragraph)
5. Potential side effects(one paragraph)
6. Lab monitoring/ follow up (one paragraph)
7. Explain the role of the Psychiatric Mental Health Nurse Practitioner in the role of prescribing the medication (one paragraph)
8. Explain the role of the Psychiatric Mental Health Nurse Practitioner in the role of managing the medication (one paragraph)
9. Conclusion (one paragraph)
Parts 3 and 4 have the same questions. However, you must answer with references and different writing, always addressing them objectively, as if you were different students. Similar responses in wording or references will not be accepted.
Part 3: Inclusive Recreation Services
Topic: Ethical Assumptions and Leisure
Read the eight statements presented below:
a. Assumption #1 (Humans): All People Deserve Our Respect
b. Assumption #2 (Humans): Everyone Has the Right to Self-Determination
c. Assumption #3 (Humans): No One Can Be Reduced to One Characteristic
d. Assumption #4 (Ideals): Inclusion Is Good
e. Assumption #5 (Ideals): Diversity Enriches Our World
f. Assumption #6 (Service Providers): With Great Power Comes Great Responsibility
g. Assumption #7 (Service Providers): We Ought to Consider Perspectives Different From Our Own
h. Assumption #8 (Service Providers): Critical and Constructive Thinking Contribute to a More Just Society
1. Describe why you think each of these assumptions are listed at the beginning of the Textbook “Inclusive Leisure Services”(4TH Ed). (Three paragraphs)
a.
b.
c.
d.
e.
f.
g.
h.
2. Which of these assumptions do you think are the most important? (One paragraph)
a. Explain reasons why you selected these particular assumptions.
3. Which of the assumptions have you spent limited time thinking about? (One paragraph)
a. Explain
4. Select one of the assumptions. (One paragraph)
a. What is the relationship between that assumption and providing inclusive leisure services?
Part 4: Inclusive Recreation Services
Topic: Ethical Assumptions and Leisure
Read the eight statements presented below:
a. Assumption #1 (Humans): All People Deserve Our Respect
b. Assumption #2 (Humans): Everyone Has the Right to Self-Determination
c. Assumption #3 (Humans): No One Can Be Reduced to One Characteristic
d. Assumption #4 (Ideals): Inclusion Is Good
e. Assumption #5 (Ideals): Diversity Enriches Our World
f. Assumption #6 (Service Providers): With Great Power Comes Great Responsibility
g. Assumption #7 (Service Providers): We Ought to Consider Perspectives Different From Our Own
h. Assumption #8 (Service Providers): Critical and Constructive Thinking Contribute to a More Just Society
1. Describe why you think each of these assumptions are listed at the beginning of the Textbook “Inclusive Leisure Services”(4TH Ed). (Three paragraphs)
a.
b.
c.
d.
e.
f.
g.
h.
2. Which of these assumptions do you think are the most important? (One paragraph)
a. Explain reasons why you selected these particular assumptions.
3. Which of the assumptions have you spent limited time thinking about? (One paragraph)
a. Explain
4. Select one of the assumptions. (One paragraph)
a. What is the relationship between that assumption and providing inclusive leisure services?