Culture on Prescription - Rehabilitation through Cultural Activities

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1 Culture on Prescription - Rehabilitation through Cultural Activities No interest to declare

2 Culture on Prescription - Rehabilitation through Cultural Activities Inger Jansson Occupational therapist PhD Jönköping University Birgitta Ekeberg Nurse/music therapist Public Health and Healthcare

5 Why?

6 Sick Leave Statistics, Sweden Approx. 35% Other diseases Approx. 40% Mental illness Approx. 25% Non- specific pain diseases

7 Sick Listing is a Strong Medicine with Side Effects e.g. Isolation Loss of identity Loss of structure in everyday life Economic consequences Decreased self-esteem Depression Limited social relations Impaired lifestyle Limited scientific evidence

8 The drugs song

9 video

10 Culture on prescriptionrehabilitation through cultural activities Experiences Activities Own creation

11 A gentle way back.. Today there is a gap between passive sick leave and return to work. There is no occasion where the patient is offered a less demanding measure in an early stage of their sick leave

12 The purpose with cultural prescription is to: - improve well-being both physically and mentally - Improve work ability and return to work

13 Target group Sick listed people in working age (18 65) with: - CMD common mental disorders (mild, and moderate depression, stress and anxiety) - Non-specific pain

14 Culture on Prescription Is always carried out in groups, 6 9 participants Twice a week/ 2.5 hours per session / 10 weeks; total 22 sessions Participants has to be able to transport themselves to cultural activities The activities are combined with conversations about the experiences The participants keep their ongoing treatment in primary health care Participation in Culture on prescription is free of charge

15 Cultural Activities smörgåsbord Song/music Drama /theatre Dance/movement Own creation; Test various forms of handicraft for example painting, pottery, felting The group attends e.g. concerts, theatres, art exhibitions and libraries

16 The Culture-card Kulturkortet

17 Comments from Participants - Good in an early stage - Without demands - Reason to get out of bed that day! - Get out of the house, meet others, fun! - Feeling low before gets happy and inspired - It feels so nice - The meetings have been fun - Group acceptance you can be who you are - Finally found friends that I don t have to explain to - The cultural operators know their stuff! - Structure is good

18 Results Results from focus group interviews Preliminary results from surveys before and six months after Culture on prescription

19 Participants in focus groups 31 participants were interviewed 16 participants were interviewed twice 15 participants were interviewed at one occasion All participants were women Interview question: Experiences of Culture on prescription

20 Focus group interviews, participants Directly after Culture on prescription Number participants Three months after Culture on prescription Number participants Mean age (min-max) Group 1 (n=7) 6 4 Group 2 (n=8) 8 7 Group 3 (n=7) 5 6 Group 4 (n=7) 7 Group 5 (n=6) 4 46 (37-54) 51 (65-40) 43 (32-54) 32 (20-51) 40 (30-50)

21 Results from focus group interviews Theme: Imagine that a backward somersault can lead to a step forward Categories From isolation to fellowship Dare to be and dare to do About the activities Impact on everyday life

22 Category: From isolation to fellowship Losses The group versus the rest of society If someone feels bad, then the rest of us know what it is about Interview 1 Generates as well as absorbes energy Laughter To be able to laugh, to laugh together, well that I think it was the first time we were here and we had drama, we laughed all the time. Interview 4

23 Category: Dare to be and dare to do To be who you are for the moment Here we accept that sometimes you feel glad and sometimes you feel bad. Not that if you feel bad you have to feel bad all the time. Interview 6. Meet challenges To not take everything so seriously, it will solve itself, I mean I ll keep on going and see what s happening. Interview 2 To succeed or to fail

24 Category: About the activities Talking and doing You sit and do things on your own but you are together with others. Interview 4 Letting oneself go Testing and challenging Before some activities I was nervous about what to do for example painting but it was really relieving. Interview 7 Taking in information

25 Category: Impact on everyday life Decreased symptoms Manage more I ve had huge problems to get into the car and take myself to places, because I ve had so much panic anxiety but now.i can take myself to and from places, I don t feel any panic anxiety. Interview 2 Dare more If I can sing together with others then I can work in a production line I said to my perplexed social insurance agency official. Interview 4 Will to deal with oneself

26 Data collection - quantitative Demographic data e.g. sick leave, return to work Self-rated work ability WAI (Work Ability Index) Perceived self efficacy GSE (General Self- Efficacy Scale) Perceived sense of coherence SOC (Sense of Coherence) Health related quality of life EQ5D (Euro-Qol-5 dimensions) Perception of pain - activity FRI (Functional Rating Index) Anxiety and depression HADS (Hospital Anxiety and Depression Scale) Stress SCI-93 (Stress and Crises Inventory) Sleep and recovery KSQ (Karolinska Sleep Questionnaire)

27 Participants (n=76) 96 % women 46 years mean age 16 months sick leave (mean)

28 Results quantitative data, preliminary On sick leave Return to work Self-rated health Sense of Coherence Anxiety Depression Self efficacy Self-rated work ability

29 On Sick Leave and in Work Before and Six Months After Culture on Prescription (CoP). 85% % 38% % Before CoP (n=76) Sick leave Six months after CoP (n=43) Work

30 Preliminary results, quantitative data N= 43 Before CoP Six months after CoP p-value Self rated health EQ5D 8,5 8 0,01 Sense of Coherence SOC Anxiety HADS-A Depression HADS-D Self efficacy GSE Work ability WAI No significant difference , , , ,00

31 Cooperation Model in Jönköping County Culture on Prescription

32 The Cooperative Model - The Model - The Economy

33 The Model Rehabilitation coordinator Cultural coordinator Cultural operator

34 Rehabilitation coordinator (Healthcare) - Responsible for patients sick listed for more than 28 days

35 Cultural coordinator (Municipality) Spider in the web Contact with: - healthcare during the rehabilitation - participants during the rehabilitation - cultural operators Plans for 20 sessions. Meets groups on 5 occasions Referral answer to healthcare Professional Secrecy

36 Cultural operator (Community) Professional within their cultural areas and in meeting the people in the groups Knowledge of the target group s problems as a whole, not on an individual level Meets participants on 3 occasions Notifies participants non-attendance to cultural coordinator Vow of Silence

37 The Economy - Cultural coordinator (employed by the municipality) Preliminary 25 hours/group - Costs of a cultural prescription group skr/group Region Jönköpings county and the municipalities share the costs for the groups

38 Mullsjö Habo Vättern Tranås Aneby Jönköping Nässjö Eksjö Vaggeryd Gnosjö Sävsjö Vetlanda Gislaved Värnamo

39 Rehabilitation coordinator Cultural coordinator Cultural operator

40 Birgitta Ekeberg Inger Jansson Paula Bergman

Individuals in work or in labour market measures before and after Culture on prescription (CoP) 14

42 Individuals in work or in labour market measures before and after Culture on prescription (CoP) Before CoP (n=76) In work Six months after CoP (n=43) Labour market measures

43 On Sick Leave and in Work Before and Six Months After Culture on Prescription (CoP). Part time like 25 %, 50 % and 75 % are summed up to full time i. e.100 % equivalent to 40 hours/week Before CoP (n=76) Sick leave Six months after CoP (n=46) Work

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