Action research needed for geriatric mental health intervention
A 90-year-old woman sits at the front gate of her house in Fuqing, Fujian Province. Photo: Weng Rong/CSST
As China’s population ages further, older adults’ mental well-being has become an increasingly important subject. More research has been done on how the community influences older social members’ mental health, such as a study that indicates that as elderly people’s individual ability decreases and more life events start to take place, they tend to become more sensitive to their surroundings, and are more dependent on the environment and resources of the neighborhood. Therefore, community has become a practical place to start with geriatric mental health intervention.
Mental intervention
Currently, China has done relatively little research on using community resources to carry out mental intervention for senior social members. Research on geriatric mental intervention is mostly done in the medical and psychological fields. Medical research focuses mainly on the elderly with two specific kinds of diseases: outpatients or hospitalized patients with somatopathy like hypertension, and those with mental diseases or emotional disorders. Psychological studies focus more on senior patients with psychological illnesses. Whereas the studies conducted on ordinary senior members are mainly done by specialized persons with specialized methods, the intervention programs with the aid of community resources are still lacking. Meanwhile, although many have called for filling the gap, not much has been done beyond theoretical discussions.
Between 2011 and 2018, a mental intervention study for the elderly was carried out in the rural areas of 10 provinces and municipalities in China by Tsinghua University’s Research Center for Public Health, the Department of Sociology at the Central University of Finance and Economics, School of Public Health at Central South University, and the Harvard University Asian Center. The research team carried out a seven-month mental intervention in each of the locations, and used experimentation to evaluate the results. The results show that the intervention method with the “gatekeeper” model at its core is able to improve the social support for elderly people, and create a friendly rural community in which senior residents can enjoy better mental health and a happier old age. The model features an intervention route with the Party’s officials working at the primary level as the leader, neighbors as friends, and family members as supporters.
Action research
“Action Research” was first created in the early 20th century by Kurt Lewin, who described the term as research done in practical work, which is the joint effort of actual workers and researchers. The goal of the research result is for actual workers to understand a practical problem and find out its solutions. Our intervention research shows that action research is effective in carrying out geriatric mental health intervention for the following reasons.
First, action research values pragmatism, and community-based mental intervention values instant effects. The basic concept of pragmatism is to let theory guide action, and its ultimate pursuit is to respond to reality. The best part of action research is that it fuels the efficacy of action, which is also what distinguishes action research from other conventional research methods.
In conventional research, the attitude of “putting science first” tends to grant the research a superior perspective, from which the researcher observes, analyzes, and studies the real world while keeping a distance from it. Sometimes, a long process must be endured so that research results can be transformed into a policy, which then guides the reality. Consequently, it is difficult to reach the goal of letting academic results guide real-life practice.
Mental intervention research calls for instant, real-time, and concrete effects, and action research answers this call, for it is practical. When carrying out the intervention research, we aimed for actual results, and continuously supervised and evaluated the intervention effect, while adjusting and optimizing the scheme based on actual conditions. Throughout this process, the elderly acquired various types of support as their mental health continued to improve. Researchers and local participants observed and evaluated how the entire community was motivated to care for the old, while they made adjustments throughout the process. Pragmatism is not only a guiding principle for mental intervention research, but an important effectiveness evaluation criterion.
Second, action research bestows more rights on research actors, and the community-based psychological intervention research is in urgent need of being initiated by and relying on community actors. In conventional research, local actors, as non-professionals, are usually unable to obtain a dominant role in the research, and are even shut out by the high barriers of expertise, making it difficult for them to transform academic research into effective information to guide practical actions. One of the reasons for the gap between theory and practice in many research projects lies in the neglect of the possible contribution made by the local actors. The local actors should and will take on the most critical role in bridging the gap between theory and practice.
If the effectiveness of local actors is to be enhanced in the action research, it is necessary to respect local actors’ rights and knowledge and allow local actors to become carriers of research together with researchers.
Our intervention research introduces the “Gatekeeper” model, which advocates the establishment of a psychological screening network and a protection system for the elderly at the community level by mobilizing and training ordinary people and encouraging public participation and stimulating the internal efficiency of the community. The “gatekeeper” model has been proved by many studies to be the most effective psychological intervention program geared to senior citizens that are socially alienated. In this research, county and town government officials, village cadres, village doctors, and volunteers in the village and other ordinary persons in the community were recruited as the “gatekeepers” of the intervention, and became the direct intervenors for elderly care after getting trained for the elderly’s mental health knowledge and preliminary screening. “Gatekeepers” are local actors, direct intervenors for the elderly’s psychological health in the community, associated persons acquainted with local interpersonal relationships as well as masters of local knowledge. More often than not, they know the actual situation better than the researchers and are more likely to come up with some feasible solutions. The intervention programs put forward by the researchers are based on expertise and previous experience, but its implementation must be carried out by the local actors in a manner appropriate to local conditions.
In the Sichuan project site, psychological health knowledge was incorporated into the song lyrics of the local Huagu Opera (Flower Drum Opera) for the elderly to sing and memorize. In the Shandong project site, square dances were introduced to the elderly to provide a source of entertainment to enrich their lives. Each project site has compiled its own publicity slogan according to the local culture to make the intervention activities resonate with the people.
The research is not exclusive to the researchers, and neither is the knowledge. When the local actors become the executors, who turn the theory into practice, the research can serve the elderly. Compared with the psychological intervention on other demographic groups, it is of more practical significance and feasible value for the local actors to start the construction of a psychological protection system at the community level so as to conduct psychological intervention for the elderly.
Third, action research is a kind of reflective study using scientific approaches, and research on a community’s psychological intervention is usually dominated by scientific experiments. The ultimate objective of action research is to realize its social value and theoretical value. The preconditions for promoting efficient practices include scientific approaches, tests, and results. Both of them are on the same page, when it comes to pursuit of scientific rationality.
Meanwhile, the reflective features of action research provide reference for research on a community’s psychological intervention. Action research holds that research should be realized in practical actions—endless exploration, summary, and reflection, so as to really promote the quality of action. We act and study, and study and act, in a mutually reciprocal way, so as to make a spiral progression. In our intervention research, all psychological intervention schemes constitute a theoretical framework, whose specific schemes will be modified constantly based on local culture and specific situations, and sometimes even the theoretical framework needs to be supplemented and optimized. For example, in the initial stage of our program, we decided that more social support should be a measure to better the mental health of the elderly in the community, and the social support theory has been our basic framework. Nevertheless, during the process of intervention, our field survey shows that the social support system for the elderly in rural communities have seen great changes due to the impact of social transformation and cultural vicissitude. The support from family, neighborhood, community, and the government have quite complicated roles and different mobilization mechanisms.
After repeated cycles of “theory-practice-reflection-modification-testing,” we have worked out a final intervention scheme, representing a shift from relying on the social support theoretical framework to relying on the community, which better suits traditional Chinese culture and our national conditions. Apparently, the reflective features of action research will provide provoking enlightenment for this kind of operate-and-check research like psychological intervention.
The report to the 19th CPC National Congress pointed out that we need to make steady progress in ensuring people’s access to elderly care, “as we respond proactively to population aging, we will adopt policies and foster a social environment in which senior citizens are respected, cared for, and live happily in their later years.”
The community is the most important living environment for the elderly, therefore we should fully leverage its resources to conduct geriatric mental intervention. For that to happen, we need to utilize action research, let theory guide practice, and roll out programs in the community based on scientific results so that academic efforts can truly benefit the people.
Sun Weiwei is an associate professor from the Department of Sociology at the School of Sociology and Psychology at the Central University of Finance and Economics.
Edited by WENG RONG