Abstract
A disproportionate number of people with mental ill-health experience social exclusion. Appropriate measurement tools are required to progress opportunities to improve social inclusion. We have developed a novel measure, the Filia Social Inclusion Measure (F-SIM). Here we aimed to present a more concise, easy-to-use form, while retaining its measurement integrity by (i) refining the F-SIM using traditional and contemporary item-reduction techniques; and (ii) testing the psychometric properties of the reduced measure. Five hundred and six participants completed the F-SIM, younger and older groups of people with serious mental illness (including psychosis, mood, anxiety disorders) and same-aged community counterparts. The F-SIM was completed at baseline and 2-week follow-up, alongside other measures (including social inclusion, loneliness). The F-SIM was refined using multidimensional scaling network analysis, confirmatory factor analysis and item response theory. The psychometric evaluation included assessment of dimensionality, internal consistency, test-retest reliability, discriminant ability and construct validity. The F-SIM was reduced from 135-items to 16; with 4-items in each domain of housing and neighbourhood, finances, employment and education and social participation and relationships. Psychometric properties were sound, including strong internal consistency within domains (all α > 0.85) and excellent overall (α = 0.92). Test-retest reliability was also high (γ = 0.90). Differences between groups were observed; clinical subgroups consistently reported lower levels of social inclusion compared to community counterparts. The F-SIM16 is a sound, reliable, brief self-report measure of social inclusion suitable for use in clinical and research settings. It has the potential to evaluate the effectiveness of interventions, and aid in fostering targeted and personalised needs-based care.
Highlights
While traditionally mental health care focused on the reduction and/or elimination of distressing symptomatology (Slade et al, 2014; van Os et al, 2019), more recently the recovery movement has shifted focus to person-centred holistic care, acknowledging the importance of participation in society (Davidson, 2016)
Many of these domains are characteristic of social inclusion (Filia et al, 2018), a relatively new concept in the mental health field, with a focus on the degree to which a person participates in their communities (Productivity Commission, 2019)
It was determined that health items should be measured independently of social inclusion to account for different health conditions, and allow for a clearer assessment of the relationship between both
Summary
While traditionally mental health care focused on the reduction and/or elimination of distressing symptomatology (Slade et al, 2014; van Os et al, 2019), more recently the recovery movement has shifted focus to person-centred holistic care, acknowledging the importance of participation in society (Davidson, 2016). In conjunction with the treatment of symptoms (Le Boutillier et al, 2011; Slade et al, 2014), there has been more consideration of education and employment, finances, housing, physical health, community participation and quality of life (van Os et al, 2019); areas highly valued by people with mental ill-health and their families (Connell et al, 2014; Robotham et al, 2016) Many of these domains are characteristic of social inclusion (Filia et al, 2018), a relatively new concept in the mental health field, with a focus on the degree to which a person participates in their communities (Productivity Commission, 2019). Relationships between these domains, and the impact and direction of the relationship with mental health remain underexplored
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